The diagnostic utility of intracranial EEG monitoring for epilepsy surgery in children

This chapter reviews the application of intracranial EEG monitoring and cortical stimulation in the surgical treatment of tuberous sclerosis (TS) patients with uncontrolled epilepsy. It begins with a review of issues related to seizure localization and determination of epileptogenic tubers, followed by a review of surgical series in which intraoperative electrocorticography (ECoG) or extraoperative EEG monitoring with subdural or depth electrodes was utilized. Specific interictal and ictal EEG patterns suggesting intrinsic epileptogenicity of tubers are described, and similarities with focal cortical dysplasia are emphasized. The discussion is illustrated with examples of invasive EEG findings in patients with TS, and their relationship to the centre and rims of epileptogenic and non-epileptogenic tubers, and to perituberal and remote cortex. The chapter provides a comprehensive resource that will help epileptologists and neurophysiologists to decide on the need for invasive EEG, and the significance of findings, in TS patients with uncontrolled epilepsy.

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The Irritative Zone and Seizure Onset Zone in Acute ECOG: The Quest for Relevant Epileptogenic Tissue

Invasive Studies of the Human Epileptic Brain ◽

10.1093/med/9780198714668.003.0010 ◽

2018 ◽

pp. 120-130

Author(s):

André Palmini ◽

Eliseu Paglioli

Keyword(s):

Epilepsy Surgery ◽

Cost Effective ◽

Careful Analysis ◽

Cortical Surface ◽

Interictal Spikes ◽

Intracranial Eeg ◽

Seizure Onset Zone ◽

Cost Effective Approach ◽

Lesion Type ◽

Refractory Seizures

Acute intraoperative electrocorticography (ECoG) is a time-honoured technique to identify the relevant epileptogenic tissue (RET) and hence guide cortical resection to control medically refractory seizures. ECoG identifies the RET through careful analysis of pattern, morphology, frequency, and localization of interictal spikes recorded directly from the exposed cortical surface. Because the development and dissemination of chronic intracranial EEG recording techniques has put emphasis on ictal recordings (thus defining an ictal onset zone), acute ECoG is often considered unnecessary in surgical planning. The chapter describes limitations and advantages of acute ECoG to define the RET in comparison with more costly and risky procedures, particularly subdural grid and SEEG recording. Specifically, it shows how the integration of lesion type and sequentially recorded ECoG spikes during operation may provide a highly cost-effective approach to successful epilepsy surgery.

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Correlation of99mTc-HMPAO SPECT with EEG monitoring: prognostic value for outcome of epilepsy surgery in children

Brain and Development ◽

10.1016/0387-7604(95)00066-6 ◽

1995 ◽

Vol 17 (6) ◽

pp. 409-417 ◽

Cited By ~ 7

Author(s):

Bryan J. Lynch ◽

Lorcan A. O'Tuama ◽

S. Ted Treves ◽

Mohamad Mikati ◽

Gregory L. Holmes

Keyword(s):

Epilepsy Surgery ◽

Prognostic Value ◽

Eeg Monitoring ◽

Hmpao Spect

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Subclinical seizures detected on intracranial EEG: Patient characteristics and impact on surgical outcome in a single pediatric epilepsy surgery center

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.108040 ◽

2021 ◽

Vol 121 ◽

pp. 108040

Author(s):

Melissa Tsuboyama ◽

Chellamani Harini ◽

Shanshan Liu ◽

Bo Zhang ◽

Jeffrey Bolton

Keyword(s):

Epilepsy Surgery ◽

Surgical Outcome ◽

Patient Characteristics ◽

Pediatric Epilepsy ◽

Intracranial Eeg ◽

Pediatric Epilepsy Surgery ◽

Surgery Center

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Corpus callosotomy in multistage epilepsy surgery in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10334 ◽

2011 ◽

Vol 7 (2) ◽

pp. 189-200 ◽

Cited By ~ 19

Author(s):

Jessica S. Lin ◽

Sean M. Lew ◽

Charles J. Marcuccilli ◽

Wade M. Mueller ◽

Anne E. Matthews ◽

...

Keyword(s):

Epilepsy Surgery ◽

Refractory Epilepsy ◽

Initial Step ◽

Electrode Placement ◽

Invasive Monitoring ◽

Eeg Monitoring ◽

Corpus Callosotomy ◽

Epileptiform Discharges ◽

Select Group ◽

Medically Refractory Epilepsy

Object The object of this study was to evaluate surgical outcome in a select group of patients with medically refractory epilepsy who had undergone corpus callosotomy combined with bilateral subdural electroencephalography (EEG) electrode placement as the initial step in multistage epilepsy surgery. Methods A retrospective chart review of 18 children (ages 3.5–18 years) with medically refractory symptomatic generalized or localization-related epilepsy was undertaken. A corpus callosotomy with subdural bihemispheric EEG electrode placement was performed as the initial step in multistage epilepsy surgery. All of the patients had tonic and atonic seizures; 6 patients also experienced complex partial seizures. All of the patients had frequent generalized epileptiform discharges as well as multifocal independent epileptiform discharges on surface EEG monitoring. Most of the patients (94%) had either normal (44%) MR imaging studies of the brain or bihemispheric abnormalities (50%). One patient had a suspected unilateral lesion (prominent sylvian fissure). Results Of the 18 patients who underwent corpus callosotomy and placement of subdural strips and grids, 12 progressed to further resection based on localizing data obtained during invasive EEG monitoring. The mean patient age was 10.9 years. The duration of invasive monitoring ranged from 3 to 14 days, and the follow-up ranged from 6 to 70 months (mean 35 months). Six (50%) of the 12 patients who had undergone resection had an excellent outcome (Engel Class I or II). There were no permanent neurological deficits or deaths. Conclusions The addition of invasive monitoring for patients undergoing corpus callosotomy for medically refractory epilepsy may lead to the localization of surgically amenable seizure foci, targeted resections, and improved seizure outcomes in a select group of patients typically believed to be candidates for palliative surgery alone.

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