Introduction: Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision-making in focal epilepsy, there are no prior reports of SEEG in the American pediatric population. In this study, we present the results of our experience using SEEG in pediatric patients and offer an algorithm for patient selection based upon seizure semiology, MRI findings, superficial EEG and ancillary testing.
Methods: A retrospective analysis was performed on 28 pediatric patients (9 girls, 19 boys, mean age 14 ±3.9 years) with medically refractory epilepsy who were determined to be candidates for invasive EEG monitoring and underwent tailored SEEG insertion and monitoring. MRI findings, EZ localization, seizure-free outcomes, type of surgery performed, and complications were evaluated. A classification scheme for potential SEEG candidates based on non-invasive findings was developed and applied to the current series of patients.
Results: Eighteen patients (64.3%) underwent a resection after SEEG implantation. In the patients who did not undergo resection, there were various reasons considered: EZ localization failed (four patients), multifocal EZ found (two patients), EZ in eloquent, unresectable location (one patient), and family declined resection (two patients). In the patients who subsequently underwent resection, follow-up ranged from 4-23 months. Thirteen patients (72%) experienced seizure improvement and five (28%) were seizure-free (Engel Ia).
Conclusions: This study demonstrates that SEEG is a safe and effective method to localize the EZ in medically refractory pediatric epilepsy patients. Furthermore, we suggest an algorithm for standardizing appropriate SEEG candidates in the pediatric population. Nonetheless, long-term follow-up will be necessary to better evaluate and validate our results.
Patient Care: Our research will hopefully allow clinicians more opportunities to better determine the epileptogenic zone in pediatric patients and in some offer resective surgery that will allow seizure free survival.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the role of SEEG in pediatric epilepsy patients 2) Consider the proposed decision making algorith before deterimining invasive montiring in their patients