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Preresection intraoperative electrocorticography ( EC oG) abnormalities predict seizure‐onset zone and outcome in pediatric epilepsy surgery
Author(s) -
Greiner Hansel M.,
Horn Paul S.,
Tenney Jeffrey R.,
Arya Ravindra,
Jain Sejal V.,
Holland Katherine D.,
Leach James L.,
Miles Lili,
Rose Douglas F.,
Fujiwara Hisako,
Mangano Francesco T.
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13341
Subject(s) - electrocorticography , epilepsy surgery , epilepsy , medicine , population , anesthesia , electroencephalography , surgery , psychiatry , environmental health
Summary Objective The predictive value of intraoperative electrocorticography ( EC oG) in pediatric epilepsy surgery is unknown. In a population of children undergoing EC oG followed typically by invasive extraoperative monitoring ( IEM ) and resection, we aimed to determine the relationship between frequent EC oG abnormalities and the seizure onset zone and outcome after resection. Methods We retrospectively identified 103 children with preresection EC oG of sufficient technical quality. EC oG records were scored based on electrode location and frequency, blinded to the seizure‐onset zone and outcome. Electrographic seizure and spike locations were identified. Locations of seizures and spike populations were then compared to the location of seizure‐onset zone defined by IEM using subdural electrodes and resection margin. Results Electrographic seizures were identified in 11 (11%) of 103 patients. A spike population of one or more was noted in 79 (77%) of 103 patients. In 50 (63%) of 79 patients, spike populations correlated with seizure‐onset zone location. The overall surgical outcome was good ( ILAE 1 to 3) in 53 (52%) of 101 patients. Outcome was good in seven (78%) of nine patients when electrographic seizure location was resected. The best outcomes were obtained with resection of both the seizure‐onset zone and EC oG abnormalities to include seizures and spike locations (22/33 good outcome, 67%, p = 0.008). There was a significantly better outcome in children with complete resection of EC oG‐identified spike populations (14/26, 62% good outcome) compared to when none were resected (4/14, 29%, p = 0.043). Significance Electrographic seizures and frequent spikes are frequently seen on pre‐resection EC oG in children. The brain locations corresponding to these discharges are highly concordant with the seizure‐onset zone; resection of these regions is correlated with good seizure outcome. Further research is needed to design interventions that increase the reliability of EC oG prediction of the epileptogenic zone and obviate the need for IEM .