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Outcomes of stereoelectroencephalography following failed epilepsy surgery in children

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Abstract

Introduction

Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children.

Objective

The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery.

Methods

In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023.

Results

Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months.

Conclusion

SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.

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Abbreviations

EZ:

Epileptogenic zone

EEG:

Electroencephalography

FCD:

Focal cortical dysplasia

iEEG:

Intracranial electroencephalography

LITT:

Laser interstitial thermal therapy

MCD:

Malformation of cortical development

MRI:

Magnetic resonance imaging

rSOZ:

Residual seizure onset zone

SEEG:

Stereo-electroencephalography

SOZ:

Seizure onset zone

TLE:

Temporal lobe epilepsy

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA

    Georgia M. Wong

  2. Department of Neurosurgery, Children’s National Hospital, Washington, DC, 20012, USA

    Ashley McCray, Saige Teti & Chima O. Oluigbo

  3. Department of Neurology, George Washington University School of Medicine, Washington, DC, USA

    Kara Hom, Nathan T. Cohen & William D. Gaillard

  4. Department of Neurology, Children’s National Hospital, Washington, DC, USA

    Nathan T. Cohen & William D. Gaillard

Authors
  1. Georgia M. Wong
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  2. Ashley McCray
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Correspondence to Georgia M. Wong or Chima O. Oluigbo.

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Wong, G.M., McCray, A., Hom, K. et al. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06420-w

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