Determinants of Epileptogenic Zone Identification and Seizure Outcome in Children with Refractory Epilepsy Undergoing Stereoelectroencephalography (SEEG)
Abstract number :
2.285
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2205012
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Jason Hsieh, MD, MS – Cleveland Clinic Foundation; Swetha Sundar, MD – Department of Neurosurgery – Cleveland Clinic Foundation; Elaine Lu, BS – Case Western Reserve University School of Medicine; Ansh Desai, BS – Case Western Reserve University School of Medicine; Ahsan Moosa, MD – Charles Shor Epilepsy Center – Cleveland Clinic Foundation; Ajay Gupta, MD – Charles Shor Epilepsy Center – Cleveland Clinic Foundation; Lara Jehi, MD – Charles Shor Epilepsy Center – Cleveland Clinic Foundation; William Bingaman, MD – Charles Shor Epilepsy Center – Cleveland Clinic Foundation; Juan Bulacio, MD – Charles Shor Epilepsy Center – Cleveland Clinic Foundation
Rationale: In pediatric patients, there is a limited understanding of the factors that impact SEEG strategy and seizure outcomes. In a complex population of pediatric patients undergoing first-time SEEG, we investigated whether there were baseline clinical factors associated with successful epileptogenic zone (EZ) identification and postoperative seizure freedom.
Methods: We included patients < 18 years of age without prior epilepsy surgery who underwent SEEG between 2009-2020. We collected data from the medical record and multidisciplinary epilepsy management conference records to explore the relationship between baseline factors and clinical outcomes. For our primary outcome, we tested the bivariable relationship between baseline factors and successful EZ identification. For our secondary outcome, we investigated whether there were factors that predicted postoperative seizure freedom, using multivariable methods.
Results: We included 101 patients with average age 15.2 years and epilepsy duration 7.4 years. 39.6% had an MRI lesion, and etiology was idiopathic or cryptogenic in 62.3%. An average 13.2 electrodes were implanted for a median 9.7 days. EZ was identified in 88 (87.1%) patients. 83 (82.2%) underwent surgery: of those, 87.5% had resection or laser ablation. Fifty percent of these patients achieved Engel I outcomes with median 25 months of follow-up. The remaining 12.5% underwent neuromodulation and none were seizure-free postoperatively. Patients with an older age of onset (OR 1.20/yr, p = .04), and those with structural developmental abnormalities (OR 8.38, p = .02) were more likely to have EZ identification. Patients with bilateral preimplantation hypotheses (OR 0.29, p = .047) and longer duration of SEEG (OR 0.86/d, p = .006) were less likely to have their EZ defined. On secondary one-tailed analysis, an MRI lesion was associated with EZ identification (OR 4.18, p = .049).
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Resection and laser ablation were significantly associated with increased odds of seizure-freedom vs. neuromodulation (OR 4.85, Firth-Adjusted, p < .001). Restricting our analysis only to those who underwent resection or ablation, only a frontal/parietal pre-implantation hypothesis was associated with increased odds of seizure freedom (OR 3.64, p = .01) while controlling for bilateral hypothesis and idiopathic disease etiology. Patients who underwent laser ablation were more likely to undergo reoperation than those who underwent resection (66.7% vs. 14.7%, p = .01).
Surgery