Outcomes of stereoelectroencephalography following failed epilepsy surgery in children

Georgia M Wong; Ashley McCray; Kara Hom; Saige Teti; Nathan T Cohen; William D Gaillard; Chima O Oluigbo

doi:10.1007/s00381-024-06420-w

Outcomes of stereoelectroencephalography following failed epilepsy surgery in children

Childs Nerv Syst. 2024 Apr 23. doi: 10.1007/s00381-024-06420-w. Online ahead of print.

Authors

Georgia M Wong¹, Ashley McCray², Kara Hom³, Saige Teti², Nathan T Cohen^{3

4}, William D Gaillard^{3

4}, Chima O Oluigbo⁵

Affiliations

¹ Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA. gw294@georgetown.edu.
² Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
³ Department of Neurology, George Washington University School of Medicine, Washington, DC, USA.
⁴ Department of Neurology, Children's National Hospital, Washington, DC, USA.
⁵ Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA. COluigbo@childrensnational.org.

PMID: 38652142
DOI: 10.1007/s00381-024-06420-w

Abstract

Introduction: Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children.

Objective: The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery.

Methods: In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023.

Results: Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months.

Conclusion: SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.

Keywords: Epilepsy surgery; Failed surgery; Pediatrics; Seizures.