Authors :
Presenting Author: Yoona Lee, MD – UT Southwestern Medical Center
Irina Podkorytova, MD – UT Southwestern Medical Center
Ryan Hays, MD – UT Southwestern Medical Center
Jay Harvey, MD – UT Southwestern Medical Center
Sasha Alick-Lindstrom, MD, MPH – UT Southwestern
Alexander Doyle, MD – UT Southwestern Medical Center
Irfan Sheikh, MD – University of Texas Southwestern Medical Center at Dallas
Bradley Lega, MD – UT Southwestern Medical Center
Kan Ding, MD – UT Southwestern Medical Center
Rationale:
Post-traumatic epilepsy (PTE) is a common sequela of traumatic brain injury (TBI) and often thought to be associated with poor surgical outcomes. Stereo-electroencephalography (sEEG) has been used to improve the localization of the epileptogenic zone in recent years. The purpose of this study is to report the surgical outcome in PTE patients who underwent sEEG evaluation.
Methods:
All sEEG cases for which TBI was considered to be a potential etiological factor in the patient’s epilepsy at two Level 4 Adult Epilepsy Centers between Jan 2015 to Jan 2025 were reviewed. Included cases met the following criteria: TBI occurred before the onset of epilepsy and the duration of loss of consciousness (LOC) was greater than 30 minutes or neuroimaging showed findings consistent with prior trauma. Cases were excluded when: 1) TBI was too mild (LOC < 30 minutes); 2) No clearly described TBI history in the medical record; 3) TBI was the consequence of seizure; 4) Coexistence of other pathology that could be the cause of epilepsy. Engel classification (or reduction in seizure frequency in neuromodulation cases) at the last follow-up was used to assess the surgical outcome.
Results:
A total of 15 cases met inclusion and exclusion criteria. The median duration between the indexed TBI and the onset of PTE was 3 years (range 0-25 years). The median post-surgery follow-up duration was 24 months (range 3-108 months). Of the 15 cases, 14 had TBI related-encephalomalacia and 1 met criteria based on LOC greater than 30 minutes. Four out of the 14 had concurrent mesial temporal sclerosis (MTS) or hippocampal atrophy. 12 had multi-focal lesions from TBI. 1 had an unrelated lesion to TBI and MTS. sEEG-confirmed epileptogenic zone was concordant with structural abnormalities in 12 of these 15 cases. Of the 3 discordant cases, 1 had no structural lesions and 2 had structural lesions not corresponding to the sEEG-confirmed zone. Ictal onset was localized exclusively to the encephalomalacia region in 8 cases and to the mesial temporal region in 5 cases. Of the mesial temporal cases, 4 had concordant findings with the same region on MRI. Two had ictal onset in both encephalomalacia and mesial temporal lesions. No ictal onset was seen outside of encephalomalacia or mesial temporal lesions. Seven patients underwent either resective surgery only (5) or laser interstitial thermal therapy (2) of seizure focus, and all of them had Engel Class IA, IB, or IC outcome at the last follow-up. Three patients received resective surgery followed by neuromodulation (2 with RNS and 1 with DBS) and 1 of which had Engel 1B outcome and 2 had Engel 3A outcome. Three patients had RNS implantation with outcomes of 100%, 90%, and 0% reduction in seizure frequency respectively. Two patients declined neuromodulation options and stayed on medication management.
Conclusions:
Favorable surgical outcome is achievable in PTE population with comprehensive pre-surgical evaluation including the use of sEEG.
Funding: NA