Stereoelectroencephalography Guided Thermocoagulation and Laser Interstitial Thermal Therapy Driven by Electric-source Imaging for Focal Refractory Epilepsy in Pediatric Tuberous Sclerosis Complex
Abstract number :
1.459
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
1336
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Irene Sánchez-Miranda Román, MD – Hospital Ruber Internacional
Rafael Toledano, MD – Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
Álvaro Beltrán-Corbellini, MD, MSc – Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
Marcelo Budke Neukamp, MD – Hospital Ruber Internacional
Juan Álvarez-Linera Prado, MD – Hospital Ruber Internacional
Irene García-Morales, MD, PhD – Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
Antonio Gil-Nagel, MD, PhD – Hospital Ruber Internacional
Rationale: Above 50% of patients with tuberous sclerosis complex (TSC) have refractory epilepsy and are also at high risk of neurodevelopmental disorders. Stereoelectroencephalography guided thermocoagulation (SGTC) and magnetic resonance guided laser interstitial thermal therapy (MRgLITT) are alternative treatments for focal refractory epilepsy (FRE).
Methods: We conducted a retrospective cohort study including patients with TSC-related FRE (TSC-FRE) who underwent SGTC between 2019-2023.
Results: Four children were included. Every patient underwent first-stage SEEG implantation following an individualized anatomic-electro-clinical hypothesis including interictal electric-source imaging (iESI). Median age at epilepsy onset was 10.5 months (range 1-18) and 5.5 years (range 3-10) at first SGTC. All were responders at 2 months, 1 year, and experimented cognitive and behavioral improvement. Second SGTC was carried out in 2 patients. Two patients underwent final MRgLITT, being responders at 2 months and 1 year. No complications were reported. Currently, three of them maintain an Engel’s class I outcome beyond a one-year follow-up period.
Conclusions: SGTC driven by iESI was safe and effective as a first-stage approach in pediatric TSC-FRE. MRgLITT was equally safe and effective, and may be an alternative when suboptimal response to a first-stage SGTC.
Funding: None.
Surgery