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The UK experience of stereoelectroencephalography in children: An analysis of factors predicting the identification of a seizure‐onset zone and subsequent seizure freedom
Author(s) -
AUTHOR_ID,
Aswin Chari,
Friederike Moeller,
Stewart Boyd,
Muhammad Zubair Tahir,
J. Helen Cross,
Christin Eltze,
Krishna Das,
Thijs van Dalen,
Rod C. Scott,
Ronit Pressler,
Rachel Thornton,
Martin Tisdall,
Elliott Warren,
Jayesh Patel,
Michael Carter,
Nick Kane,
Andrew A Mallick,
Marcus Likeman,
Sarah Rushton,
Danielle Cole,
Athi Ponnusamy,
Jeen Tan,
Jonathan Ellenbogen,
John Kitchen,
Majid Aziz,
Stuart Rust,
Nina Swiderska,
Matthew Bailey,
Soňa Janáčková,
Sasha Burn,
Anand Iyer,
Jay Shetty,
Ailsa McLellan,
Jothy Kandasamy,
Drahoslav Sokol,
Elaine Hughes,
Harutomo Hasegawa,
Richard Selway,
Harishchandra Lalgudi Srinivasan,
Rinki Singh,
Nandini Mullatti,
Franz Brunnhuber,
Zaloa AgirreArrizubieta,
Robert Elwes,
Sushma Goyal,
Antonio Valentin,
Ioannis Stavropoulos
Publication year - 2021
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.16954
Subject(s) - stereoelectroencephalography , epilepsy , epilepsy surgery , medicine , retrospective cohort study , cohort , lesion , odds ratio , surgery , anesthesia , psychiatry
Objective Stereoelectroencephalography (SEEG) is being used more frequently in the pre‐surgical evaluation of children with focal epilepsy. It has been shown to be safe in children, but there are no multicenter studies assessing the rates and factors associated with the identification of a putative seizure‐onset zone (SOZ) and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Methods Multicenter retrospective cohort study of all children undergoing SEEG at six of seven UK Children's Epilepsy Surgery Service centers from 2014 to 2019. Demographics, noninvasive evaluation, SEEG, and operative factors were analyzed to identify variables associated with the identification of a putative SOZ and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Results One hundred thirty‐five patients underwent 139 SEEG explorations using a total of 1767 electrodes. A putative SOZ was identified in 117 patients (85.7%); odds of successfully finding an SOZ were 6.4 times greater for non‐motor seizures compared to motor seizures ( p = 0.02) and 3.6 times more if four or more seizures were recorded during SEEG ( p = 0.03). Of 100 patients undergoing surgical treatment, 47 (47.0%) had an Engel class I outcome at a median follow‐up of 1.3 years; the only factor associated with outcome was indication for SEEG ( p = 0.03); an indication of “recurrence following surgery/treatment” had a 5.9 times lower odds of achieving seizure freedom ( p = 0.002) compared to the “lesion negative” cohort, whereas other indications (“lesion positive, define extent,” “lesion positive, discordant noninvasive investigations” and “multiple lesions”) were not statistically significantly different. Significance This large nationally representative cohort illustrates that SEEG‐guided surgery can still achieve high rates of seizure freedom. Seizure semiology and the number of seizures recorded during SEEG are important factors in the identification of a putative SOZ, and the indication for SEEG is an important factor in postoperative outcomes.