Stereoelectroencephalography in Children: A Review

Allen L. Ho, MD; Austin Y. Feng, BS; Lily H. Kim, BA; Arjun V. Pendharkar, MD; Eric S. Sussman, MD; Casey H. Halpern, MD; Gerald A. Grant, MD

Disclosures

Neurosurg Focus. 2018;45(3):e7 

In This Article

Abstract and Introduction

Abstract

Stereoelectroencephalography (SEEG) is an intracranial diagnostic measure that has grown in popularity in the United States as outcomes data have demonstrated its benefits and safety. The main uses of SEEG include 1) exploration of deep cortical/sulcal structures; 2) bilateral recordings; and 3) 3D mapping of epileptogenic zones. While SEEG has gradually been accepted for treatment in adults, there is less consensus on its utility in children. In this literature review, the authors seek to describe the current state of SEEG with a focus on the more recent technology-enabled surgical techniques and demonstrate its efficacy in the pediatric epilepsy population.

Introduction

FOR drug-resistant focal epilepsies, resective surgery is often the most effective treatment.[33] However, patient selection for epilepsy surgery relies on a multidisciplinary approach to epilepsy workup for proper identification of the epileptogenic zone (EZ). For many patients, noninvasive diagnostic measures can be sufficient for EZ localization, but many patients will require additional invasive monitoring.[8] Stereoelectroencephalography (SEEG) is an intracranial diagnostic measure that has grown in popularity in the United States as outcomes data have demonstrated its benefits and safety.[8] SEEG was first developed by Talairach and Bancaud in France during the 1950s as part of an integrative approach to epilepsy treatment.[23] This method involves intracranial insertion of multilead depth electrodes into cortical and subcortical areas of interest. Electrographic data of focal seizures gathered from SEEG monitoring combined with clinical observations could more robustly identify seizure onset zones to target for resection. Current practice still follows this methodology, as SEEG implantation hypotheses require the synthesis of various multimodal diagnostic sources.[8,15,23]

Until recently, SEEG usage was not very common outside of France, Italy, and Canada. Possible explanations for this trend are the lack of SEEG literature in the English language and/or the technical demands and learning curve associated with this technique.[8] However, with the advent of newer technologies, such as improved imaging modalities, stereotactic image guidance, and robot-assisted navigation, SEEG is now gaining wide acceptance globally as the barriers to its adoption decrease.[8] The main uses of SEEG include 1) exploration of deep cortical/sulcal structures; 2) bilateral recordings; and 3) 3D mapping of EZs. Prior to any invasive monitoring, a full multidisciplinary diagnostic workup should be completed to ensure that indications are sound for further monitoring. These indications generally revolve around discrepancies between noninvasive diagnostics, and they can be summarized as follows:[3–5,7–10] 1) ictal or interictal electroencephalography (EEG) findings discordant with clinical semiology; 2) absence of cortical lesions on MRI despite convincing EEG seizure localization; 3) incongruence between abnormalities seen on MRI and EEG and clinical semiology localization, suggesting extralesional involvement; 4) focal abnormality seen on MRI discordant with electroclinical hypothesis; 5) hypothesized EZ involved with or close to eloquent areas; and 6) large, hemispheric, and/or multifocal abnormalities revealed by MRI that are discordant with localized ictal onset.

Beyond its diagnostic capabilities, SEEG can also be coupled with radiofrequency thermocoagulation, further broadening its utility.[23] While SEEG has gradually been accepted for treatment in adults, there is less consensus on its utility in children. Our literature review seeks to describe the current state of SEEG with a focus on more recent technology-enabled surgical techniques and demonstrate its efficacy for the pediatric epilepsy population.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....