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  • Utility of SEEG in Difficult to Localize Pediatric Epileptic Patients and Proposed Decision Algorithm

    Final Number:
    1019

    Authors:
    Jeffrey Mullin; Alex M Witek MD; Sumeet Vadera MD; Jorge Alvaro Gonzalez-Martinez MD PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    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.

    Methods: A retrospective analysis was performed on 25 consecutive pediatric patients (8 girls, 17 boys, mean age 14 ±3.9 years) with medically refractory epilepsy who were determined to be candidates for invasive EEG monitoring and underwent SEEG insertion and monitoring. A classification scheme for potential SEEG candidates based on non-invasive findings was developed and applied to the current series of patients.

    Results: Sixteen patients (64%) underwent a resection after SEEG implantation. In patients who underwent resection, follow-up ranged from 4-23months. Seven patients (44%) experienced some seizure improvement (Engel II or III) and five (31%) were seizure-free (Engel Ia). In this case series, no complications were documented that are attributable to the SEEG procedure, 2 patients experienced complications from resective surgery; one CSF leak and the other required revision surgery.

    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: It is our belief that SEEG is a great option in pediatric epilepsy patients and in using this technique more patients will be able to live seizure free than previously before.

    Learning Objectives: By the conclusion of this presentation, participants should be able to: 1) better understand the utility of SEEG monitoring in pediatric patients, 2) Discuss the decision algorithm in determining what if any invasive monitoring is appropriate for pediatric epilepsy patients

    References:

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