Seizure Onset Patterns Predict Outcome After Stereoelectroencephalography-guided Stereotactic Laser Amygdalohippocampotomy
Abstract number :
1.327
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204547
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Andrew Michalak, MD – Columbia University Irving Medical Center; Adam Greenblatt, MD – Fellow, Department of Neurology, Hospital of the University of Pennsylvania; Shasha Wu, MD, PhD – Associate Professor, Department of Neurology, University of Chicago; Steven Tobochnik, MD – Instructor, Department of Neurology, Brigham and Women's Hospital; Hina Dave, MD – Assistant Professor, Department of Neurology, University of Texas Southwestern Medical Center; Ramya Raghupathi, MD – Assistant Professor, Department of Neurology, Hospital of the University of Pennsylvania; Antonio Guerra, BA – Clinical Data Specialist, Neurology, University of Texas Southwestern Medical Center; James Tao, MD, PhD – Associate Professor, Department of Neurology, University of Chicago,; Garth Cosgrove, MD – Professor, Department of Neurosurgery, Brigham and Women's Hospital; Bradley Lega, MD – Associate Professor, Department of Neurosurgery, University of Texas Southwestern Medical Center; Peter Warnke, MD – Professor, Department of Neurosurgery, University of Chicago; H. Isaac Chen, MD – Assistant Professor, Department of Neurosurgery, Hospital of the University of Pennsylvania; Timothy Lucas, MD PhD – Professor, Neurosurgery, The Ohio State University Wexner Medical Center; Sameer Sheth, MD, PhD – Associate Professor, Department of Neurosurgery, Baylor College of Medicine; Garrett P. Banks, MD - Neurosurgical Fellow, Baylor College of Medicine; Neil Feldstein, MD – Associate Professor, Department of Neurosurgery, Columbia University Irving Medical Center; Brett Youngerman, MD, MS – Assistant Professor, Department of Neurosurgery, Columbia University Irving Medical Center; Guy McKhann, MD – Associate Professor, Department of Neurosurgery, Columbia University Irving Medical Center; Kathryn Davis, MD, MS – Associate Professor, Department of Neurology, Hospital of the University of Pennsylvania; Catherine Schevon, MD, PhD – Associate Professor, Department of Neurology, Columbia University Irving Medical Center
Rationale::Stereotactic laser amygdalohippocampotomy (SLAH) has emerged as a treatment for mesial temporal epilepsy.1 Stereoelectroencephalography (sEEG) is often used to precisely identify the seizure onset zone, and in theory this should improve outcomes in SLAH.2 However, given the limited spatial sampling, it is possible that sEEG may miss onset elsewhere but capture spread to the hippocampus, thus leading to false localization. Intracranial EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control.3 However, prior studies were largely done in temporal lobectomy patients. Whether the onset patterns reflect hippocampal onset or secondary propagation from nearby cortex remains unknown. In this study, we characterized the outcomes of patients who underwent single-probe SLAH after sEEG and evaluated whether sEEG SOPs predict postoperative seizure freedom.
Methods: This retrospective five-center study consisted of an analysis of patients who underwent sEEG followed by SLAH between August 2014 and January 2022. Patients were included who had sEEG confirmed seizure onset in the hippocampus with or without mesial temporal sclerosis. Patients with causative lesions (e.g., glioma) or for whom the SLAH was considered palliative were excluded. Presurgical conference data and outcomes were collected. The primary outcome was two-year Engel I classification. A SOP catalogue was developed based on analysis of current literature.3 Two independent reviewers classified the hippocampal SOPs, with disagreement resolved by committee. The most common pattern for each patient was used for analysis.
Results: A total of 58 patients were included. Overall one- and two-year Engel I outcome probability was 54% and 36%, respectively. The two year probability was 46% for patients with SOPs including low voltage fast activity or low frequency repetitive spiking, compared to 0% patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (p = 0.00015; log rank).
Conclusions: Certain SOPs predict better response to sEEG-guided SLAH. Studies accounting for potential confounders (e.g., phase I findings, extent of ablation4) are needed.
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References:
1. Wu C, Jermakowicz WJ, Chakravorti S, et al. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: a multicenter study of 234 patients. Epilepsia. 2019;60(6):1171-1183.
2. Youngerman BE, Oh JY, et al. Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography. Epilepsia. 2018;59(3):595-606.
3. Sing S, Sandy S, Wiebe S. Ictal onset on intracranial EEG: Do we know it when we see it? State of the evidence. Epilepsia. 2015;56(10):1629-1638.
4. Satzer D, Tao JX, Warnke PC. Extent of parahippocampal ablation is associated with seizure freedom after laser amygdalohippocampotomy. J Neurosurg. 2021;135:1742-1751.
Funding: NIH T32 NS07153
Surgery