The role of stereo-electroencephalography to localize the epileptogenic zone in children with nonlesional brain magnetic resonance imaging

Woojoong Kim; Min Y Shen; Frank A Provenzano; Daniel B Lowenstein; Danielle K McBrian; Arthur M Mandel; Tristan T Sands; James J Riviello; Guy M McKhann; Neil A Feldstein; Cigdem I Akman

doi:10.1016/j.eplepsyres.2021.106828

The role of stereo-electroencephalography to localize the epileptogenic zone in children with nonlesional brain magnetic resonance imaging

Epilepsy Res. 2022 Jan:179:106828. doi: 10.1016/j.eplepsyres.2021.106828. Epub 2021 Nov 24.

Affiliations

¹ Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA.
² Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, USA.
³ Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA.
⁵ Division of Pediatric Neurosurgery, Department of Neurological Surgery, Columbia University Medical Center, Columbia-Presbyterian, New York, USA.
⁶ Department of Neurology, Child Neurology Division, Children's Hospital of New York, Columbia-Presbyterian, New York, USA. Electronic address: cia11@cumc.columbia.edu.

PMID: 34920378
DOI: 10.1016/j.eplepsyres.2021.106828

Abstract

Objective: This study aimed to assess the clinical outcome and outcome predictive factors in pediatric epilepsy patients evaluated with stereo-electroencephalography (SEEG).

Methods: Thirty-eight patients who underwent SEEG implantation at the Pediatric Epilepsy Center in New York Presbyterian Hospital between June 2014 and December 2019 were enrolled for retrospective chart review. Postoperative seizure outcomes were evaluated in patients with at least 12-months follow up. Meta-analysis was conducted via electronic literature search of data reported from 2000 to 2020 to evaluate significant surgical outcome predictors for SEEG evaluation in the pediatric population.

Results: In the current case series of 25 postsurgical patients with long-term follow up, 16 patients (64.0%) were seizure free. An additional 7 patients (28.0%) showed significant seizure improvement and 2 patients (8.0%) showed no change in seizure activity. Patients with nonlesional magnetic resonance imaging (MRI) achieved seizure freedom in 50% (5/10) of cases. By comparison, 73% (11/15) of patients with lesional MRI achieved seizure freedom. Out of 12 studies, 158 pediatric patients were identified for inclusion in a meta-analysis of the effectiveness of SEEG. Seizure freedom was reported 54.4% (n = 86/158) of patients at last follow up. Among patients with nonlesional MRI, 45% (n = 24) achieved seizure freedom compared with patients with lesional MRI findings (61.2%, n:= 60) (p = 0.02). The risk for seizure recurrence was 2.15 times higher [95% confidence interval [CI] 1.06-4.37, p = 0.033] in patients diagnosed with nonlesional focal epilepsy compared to those with lesional epilepsy [ 1.49 (95% CI 1.06-2.114, p = 0.021].

Conclusion: Evaluation by SEEG implantation in pediatric epilepsy is effective in localizing the epileptogenic zone with favorable outcome. Presence of a non-lesional brain MRI was associated with lower chances of seizure freedom. Further research is warranted to improve the efficacy of SEEG in localizing the epileptogenic zone in pediatric patients with non-lesional brain MRI.

Keywords: MRI; Pediatric epilepsy; Stereo-electroencephalography (SEEG).