Clinical Characteristics and Treatment of Patients Following Intracranial Electroencephalogram Monitoring
Abstract number :
3.328
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204858
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Thuy Nguyen, MD – Children's National Medical Center; Katherine Hofmann, BS – Children's National Medical Center; Shashi Maryala, MD – George Washington University; Mohamad Koubeissi, MD – George Washington University; William Gaillard, MD – Children's National Medical Center; Chima Oluigbo, MD – Children's National Medical Center; Taha Gholipour, MD – George Washington University
Rationale: Intracranial EEG (iEEG) monitoring with subdural (grids and/or strips) and/or stereotactic (sEEG) electrodes are key procedures in surgical evaluation of patients with medically refractory focal epilepsy. However, not all patients who undergo invasive intracranial monitoring proceed with resection or ablation surgery. Here, we reviewed the types of treatment patients received in our center following iEEG evaluation.
Methods: We retrospectively reviewed and validated records from the IRB-approved Children’s National Epilepsy Surgery Database from 2005 to 2022. Patients age 0-25 years who met criteria for medically refractory epilepsy and underwent subsequent iEEG recording were included. We reviewed demographic and clinical characteristics of patients, including details of MRI findings. Outcomes included (1) resection or ablation, (2) central neurostimulation implantation, or (3) ongoing medical management following iEEG without further surgery.
Results: A total of 102 patients met inclusion criteria for our study: 80 patients (78%) had resection, 8 patients (7%) had laser interstitial thermal ablation, 8 patients (8%) had neurostimulation implantation with RNS, and 6 patients (6%) continued medical management without a surgical treatment. Age at surgery was not different between groups. Two of 6 patients (33%) in the ongoing medical management group had subdural grid/strips alone or in combination with sEEG, in contrast to 57 of 88 patients (65%) in the surgery/ablation group and 0 of 8 patients (0%) in the neurostimulation group. The mean duration of iEEG monitoring was longer in patients who proceeded with ongoing medical management compared with those who proceeded with resection/ablation (8 days vs 16 days, respectively, p = 0.002). Of the 8 patients who underwent RNS implantation, 4 had seizure onset in bilateral hemispheres, 3 patients had seizure onset in motor cortex and 1 had seizure onset in dominant language/memory area. Of the 6 patients who proceeded with ongoing medical management, 3 patients did not have seizures during iEEG despite monitoring for >14 days, 2 patients had inconclusive/widespread seizure onset results on iEEG, and 1 patient did not follow up after neurostimulation recommendation.
Conclusions: The majority of patients with medically refractory epilepsy who undergo iEEG will go on to have resection/ablation. While neurostimulation provide palliative options in some patients, a minority (near 6% in our cohort) remained on medical management. Future studies will compare long term clinical outcomes following iEEG and identify clinical characteristics that guide effective treatment options.
Funding: None
Surgery