Rationale:
Epilepsy surgery is an effective treatment option for patients with medically refractory epilepsy due to MOGHE, however, the success of surgery depends on accurate localization of the epileptogenic zone which can be challenging due to the extent of the lesion and its subtle imaging features. The aim of this project is to assess the role of stereo-EEG (SEEG) in tailoring the resection and insuring a good outcome of surgery.
Methods:
This is a single-center retrospective review of cases of medically intractable focal epilepsy that underwent surgical treatment and were diagnosed with MOGHE on pathology. Data of interest including demographic information, electro-clinical characteristics including scalp and invasive EEG, when available, as well neuro-imaging results, surgery, and outcomes were extracted from the electronic medical record.
Results:
Out of 19 patients diagnosed with MOGHE and medically intractable epilepsy, eight (42%) underwent SEEG. All seizures of each patient were thoroughly reviewed, and the precise localization of the ictal onset as well as EEG patterns were described. We reviewed the exact location of the involved electrode contacts, their relationship with the lesion on MRI and whether these contacts were included in the resection. Seventy four percent of patients were seizure free post-operatively, with variable duration of follow-up up to eight years. Seizure freedom amongst SEEG group was 88% (n=7/8) in comparison to the non-SEEG group which was 64% (n=7/11). Success rate seemed to be related not only to accurate localization and extensive resection of the lesion (or near total lobectomy) but also to the removal of areas of SEEG onset.
Conclusions:
Contribution of SEEG in improving the outcome was highlighted in the results. There was a benefit in delineating the resection in cases where non-invasive information was discordant, EEG patterns were generalized, or poorly localized and imaging findings were questionable.
Funding: none