Surgical outcomes related to invasive EEG monitoring with subdural grids or depth electrodes in adults: A systematic review and meta-analysis

Tóth, Márton; Papp, Kata Szilvia; Gede, Noémi; Farkas, Nelli; Kovács, Sándor; Isnard, Jean; Hagiwara, Koichi; Gyimesi, Csilla; Kuperczkó, Diána; Dóczi, Tamás; Janszky, József

doi:10.1016/j.seizure.2019.06.022

Cited by 28 publications

(30 citation statements)

References 56 publications

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“…Toth et al explored this room for growth in a meta-analysis on iEEG and surgical outcomes involving 1025 subdural iEEG (grid) and 974 sEEG cases; 89% of patients monitored with subdural iEEG underwent surgery and ultimately achieved a 56% seizure-free outcome rate, whereas 79% of patients monitored with sEEG received surgery, which resulted in a 65% seizure-free rate. 9 These data corroborate the assertion that surgical outcomes can therefore be significantly bettered for either iEEG approach. rs-fMRI may therefore be used in conjunction with traditional methods to help strengthen the ability to properly localize the SOZ.…”

Section: Current Surgical Outcomessupporting

confidence: 76%

“…Improvements can be made with these surgical approaches, especially in the realm of invasive preoperative monitoring for the localization of the SOZ and associated ictal zones. Toth et al explored this room for growth in a meta‐analysis on iEEG and surgical outcomes involving 1025 subdural iEEG (grid) and 974 sEEG cases; 89% of patients monitored with subdural iEEG underwent surgery and ultimately achieved a 56% seizure‐free outcome rate, whereas 79% of patients monitored with sEEG received surgery, which resulted in a 65% seizure‐free rate 9 . These data corroborate the assertion that surgical outcomes can therefore be significantly bettered for either iEEG approach.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, these modalities are invasive tools for presurgical evaluation, and come with their own risk of morbidity and mortality 8 . Additionally, a recent meta‐analysis showed that the seizure‐free outcome utilizing sEEG and iEEG was estimated at 55.9% and 64.7%, respectively 9 . The varying success rate of surgical outcome for intractable epilepsy accompanied by the risks of invasive presurgical planning creates a need for an effective, safer method for presurgical planning.…”

Section: Introductionmentioning

confidence: 99%

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Resting‐state functional magnetic resonance imaging with independent component analysis for presurgical seizure onset zone localization: A systematic review and meta‐analysis

et al. 2020

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Objective: One of the greatest challenges of achieving successful surgical outcomes in patients with epilepsy is the ability to properly localize the seizure onset zone (SOZ). Many techniques exist for localizing the SOZ, including intracranial electroencephalography, magnetoencephalography, and stereoelectroencephalography. Recently, resting-state functional magnetic resonance imaging (rs-fMRI) in conjunction with independent component analysis (ICA) has been utilized for presurgical planning of SOZ resection, with varying results. In this meta-analysis, we analyze the current role of rs-fMRI in identifying the SOZ for presurgical planning for patients with drug-resistant epilepsy. Specifically, we seek to demonstrate its current effectiveness compared to other methods of SOZ localization. Methods: A literature review was conducted using the PubMed, MEDLINE, and Embase databases up to May of 2020. A total of 253 articles were screened, and seven studies were chosen for analysis. Each study was analyzed for SOZ localization by ground truth, SOZ localization by rs-fMRI with ICA, principal component analysis, or intrinsic connectivity contrast, and outcomes of surgery. A meta-analysis was performed to analyze how ground truth compares to rs-fMRI in SOZ localization. Results: The odds ratio comparing ground truth to rs-fMRI was 2.63 (95% confidence interval = 0.66-10.56). Average concordance of rs-fMRI SOZ localization compared with ground truth localization across studies was 71.3%. Significance: In the hunt for less invasive presurgical planning for epilepsy surgery, rs-fMRI with ICA provides a promising avenue for future standard practice. Our preliminary results show no significant difference in surgical outcomes between traditional standards of SOZ localization and rs-fMRI with ICA. We believe that rs-fMRI could be a step forward in this search. Further investigation comparing rs-fMRI to traditional methods of SOZ localization should be conducted, with the hope of moving toward relying solely on noninvasive screening methods.

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Section: Current Surgical Outcomessupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Resting‐state functional magnetic resonance imaging with independent component analysis for presurgical seizure onset zone localization: A systematic review and meta‐analysis

et al. 2020

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“…The probability of being in each of these states is, therefore, different dependent upon whether the patients were treated with AEDs or underwent resective surgery (temporal or extratemporal), which is reflected in the state transition diagram of the applied model structure. We char-acteristically defined two groups: temporal and extratemporal patient groups in the short-term and long-term model, due to the well-known differences regarding the surgical outcomes among both groups [31].…”

Section: Model Structurementioning

confidence: 99%

“…A recent meta-analysis found that there is a higher chance of resective surgeries in the SDG group (88.8%), when compared with the SEEG (79%) group, with a very high follow-up proportion (95 vs 96%) in both groups. In the SDG group, seizure-free outcome hovers at 55.9%, while it was 64.7% in the SEEG group [31]. This marked deviation within surgical outcomes may be due to the different methodological approach (SDG -positioned upon the cortical surface; SEEG -positioned intraparenchymally), and varying experiences of different centers [8,32].…”

Section: Introductionmentioning

confidence: 96%

Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy

Kovács

Tóth

Jánszky

et al. 2021

Epilepsy & Behavior

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Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective. Methods: The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental costeffectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed. Results: Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money. Significance: Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.

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The End Justifies the Means—A Call for Nuance in the Increasing Nationwide Adoption of Stereoelectroencephalography Over Subdural Electrode Monitoring in the Surgical Evaluation of Intractable Epilepsy

2022

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Surgical outcomes related to invasive EEG monitoring with subdural grids or depth electrodes in adults: A systematic review and meta-analysis

Cited by 28 publications

References 56 publications

Resting‐state functional magnetic resonance imaging with independent component analysis for presurgical seizure onset zone localization: A systematic review and meta‐analysis

Resting‐state functional magnetic resonance imaging with independent component analysis for presurgical seizure onset zone localization: A systematic review and meta‐analysis

Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy

The End Justifies the Means—A Call for Nuance in the Increasing Nationwide Adoption of Stereoelectroencephalography Over Subdural Electrode Monitoring in the Surgical Evaluation of Intractable Epilepsy

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