Practice of stereoelectroencephalography (sEEG) in drug-resistant epilepsy: Retrospective series with surgery and thermocoagulation outcomes - 19/06/20
, V. Gilard a, 1, F. Le Goff a, b, N. Chastan c, N. Magne d, E. Gerardin d, D. Maltête b, A. Lebas c, S. Derrey aBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | sEEG helped to locate the epileptogenic zone in 92% of cases. |
• | sEEG complications were rare (6%) but could be major, with one death due to hematoma. |
• | Thermocoagulation reduced the frequency of seizures in 88% of cases. |
• | Three months after surgical resection, 61% of patients were seizure-free. |
Abstract |
Objective |
The aim of this study was to determine the success rate of sEEG in locating the epileptogenic zone (EZ) in patients with pharmaco-resistant epilepsy. Secondary objectives were to analyze sEEG-related morbidity and outcomes for post-sEEG thermocoagulation and cortical resection.
Methods |
Data were collected on 49 sEEGs from 46 consecutive patients between 2010 and 2018. Following sEEG, either resective or palliative surgery with vagus nerve stimulation was performed. In 8 patients, EZ thermocoagulation was performed before EEG leads were withdrawn. Outcomes were collected based on the Engel and ILAE outcome scales.
Results |
sEEG was contributive in 45 of 49 recordings, with a success rate of 92% in locating the EZ. Minor complications, such as transient neurologic deficit and electrode implantation failures, occurred in 6%. One major complication occurred, with death due to atypical late hematoma. Thermocoagulation was performed in 8 patients and stopped or significantly reduced seizure frequency in 7 (88%). Outcome of surgical resection (n=33) was good, with 20 (61%) seizure-free patients and 32 (97%) with definite improvement.
Conclusions |
Our findings suggest that sEEG is an effective technique for EZ location in patients with drug-resistant epilepsy. sEEG was contributive in up to 92% of patients, allowing thermocoagulation and/or surgical resection that resulted in seizure-freedom in two-thirds and seizure-reduction in one-third of cases. This study highlights the need for strict selection of implantation candidates, with strong initial hypothesis as to EZ location.
Le texte complet de cet article est disponible en PDF.Keywords : Epileptogenic zone, Resective surgery, Epilepsy surgery, Thermocoagulation
Plan
Vol 66 - N° 3
P. 139-143 - juin 2020 Retour au numéro
Article précédent
- Editorial board
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