Delay in Seizure Occurrence with Implantation of Stereo-eeg Electrodes: Determinants and Impact
Abstract number :
2.283
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204279
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Paige Harmon, BS – Emory University; Abdulrahman Alwaki, MD – Emory University; Leonardo Bonilha, MD – Emory University; Katie Bullinger, MD – Emory University; Brian Cabaniss, MD – Emory University; Adam Dickey, MD – Emory University; Daniel Drane, PhD – Emory University; Charles Epstein, MD – Emory University; Rebecca Fasano, MD – Emory University; Edward Faught, MD – Emory University; Evan Gedzelman, MD – Emory University; Robert Gross, MD, PhD – Emory University; Ioannis Karakis, MD, PhD – Emory University; Ammar Kheder, MD – Emory University; Dong Li, MD, PhD – Emory University; Nigel Pedersen, MD – Emory University; Andres Rodriguez, MD – Emory University; Jon Willie, MD, PhD – Washington University; Daniel Winkel, MD – Emory University
Rationale: Prior studies focusing mostly on subdural electrode arrays have suggested an “implantation effect” in seizure occurrence in the intracranial monitoring service (ICM) compared to the epilepsy monitoring unit (EMU). The purpose of this study was to evaluate if a similar delay in seizure occurrence exists also with implantation of stereo-EEG electrodes (sEEG) and assess its determinants and impact._x000D_
Methods: We evaluated all consecutive patients with drug resistant epilepsy (DRE) who were investigated at Emory University Hospital in the EMU and subsequently in the ICM exclusively with sEEG from January 2013 to December 2018. Demographic, disease related, EMU and ICM related parameters were collected, in addition to outcomes related to the sEEG implantation. Time to first seizure (clinical and/or electrographic) recorded in the ICM was the dependent variable and its association with the collected independent variables was evaluated using Pearson correlation’s coefficient for continuous variables and Wilcoxon Rank Sum test for categorical variables._x000D_
Results: A total of 117 patients (median age at sEEG implantation 36 years, 64% female) were evaluated. They had DRE (58% lesional) for approximately 15 years, averaging 3.5 seizures per month despite being maintained on a median of 2 antiseizure medications (ASMs). They were first evaluated at the EMU for a median duration of 4 days, capturing a median of 4 seizures per stay with a median delay of 1.5 days for the first recorded seizure. Subsequently, they were implanted with a median of 16 sEEG electrodes. The median delay to first recorded seizure during the ICM admission was 2.8 days. The total ICM duration was approximately 8 days with a median of 8 seizures per patient. Time to first seizure during the ICM admission correlated negatively with patient’s age at implantation (r=-0.25, p=0.005, β=-0.11, SE=0.03) and positively with patient’s time to first seizure at the EMU (r=0.22, p=0.01) and the EMU admission duration (r=0.24, p=0.008). Patients with parietal (p=0.03) or unclear (p=0.02) seizure onset zones demonstrated delay in first seizure occurrence in the ICM. Delayed occurrence of first seizure in the ICM admission was associated with reduced recorded total seizure count (r=-0.35, p=0.0001), reduced seizure clusters (p=0.003), higher chances of ASMs withdrawal (p=0.0005) and prolonged ICM duration (r=0.62, p< 0.0001). There was no association between the occurrence of the first seizure in the ICM with intraoperative implantation time, specific anesthetic parameters, sEEG count or laterality, ICM related complications or long term seizure outcome (42% Engel Class I), regardless of the type of undertaken intervention._x000D_
Surgery