Electrical Stimulation of Induced Seizures (ESIS) in the Pediatric Epilepsy Monitoring Unit (EMU) Has a High Yield, with Several Distinct Kinds of Induced Phenomena Seen
Abstract number :
2.321
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
524
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: S. Katie Ihnen, MD, PhD – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine
Darcy Krueger, MD, PhD – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine; Hansel Greiner, MD – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine; Jesse Skoch, MD – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine; Francesco Mangano, MD – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine; Ravindra Arya, MD, DM – Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine
Rationale: ESIS using stereo EEG (sEEG) has been shown to help define the epileptogenic zone in adults with drug-resistant epilepsy (DRE), complementing data from spontaneous seizures (SpSz). Here, we describe the yield and clinical determinants of ESIS in the pediatric EMU.
Methods: ESIS was performed using bipolar stimulation at low (LF; 1 Hz) and high (HF; 50 Hz) frequency, targeting gray matter contacts. Current and pulse width were modulated; charge density was < 57 µC/cm2. Induced seizures were compared to SpSz for semiology and EEG, then sorted into four bins: electroclinical habitual (semiology and EEG similar to SpSz); clinical habitual (some SpSz semiology features, with or without EEG change); electrographic (no clinical change + EEG change with evolution); and non-habitual (atypical semiology + EEG change with evolution). DRE etiology, stimulation frequency and hemisphere were explored.
Results: Twenty-five of 31 (81%) eligible patients enrolled, yielding 26 datasets from 25 patients (11F, 14M; one patient participated twice). Various ages (2-23y, median 12) and DRE etiologies (including n=7 with Tuberous Sclerosis Complex (TSC)) were included. Patients underwent 17 to 254 trials (median 144) each. Induced seizures were seen in 137/3,741 trials (3.7%), or 23/26 sessions (88%). Of these, 63 (46%) were electroclinical habitual, 32 (23%) clinical habitual, 33 (24%) electrographic and 9 (7%) non-habitual. Sixteen of 26 patients (62%) had at least one habitual seizure (electroclinical or clinical); 8/26=31% had more than one induced seizure type. There was a trend toward a lower rate of induction in TSC patients compared to others (71% vs. 95%), although TSC patients who could be induced were more likely to have exclusively habitual seizure types (4/5=80% vs. 6/18=33%). Of all those with induced seizures, 11/23 (48%) were induced at HF only; 4/23 (17%) at LF only and 8/23 (35%) at both. The right and left hemispheres were equally inducible (67/1,647 trials=3.9% vs. 70/1,957 trials=3.5%). Considering habitual types only, there was a hemispheric difference, with clinical habitual seizures more likely on the left and electroclinical habitual seizures more likely on the right (26/39=67% vs. 50/56=89%; p < 0.05 by Fisher Exact Test).
Surgery