Leaving tissue associated with infrequent intracranial EEG seizure onsets is compatible with post-operative seizure freedom

Cyrus Huang; Eric D. Marsh; Daniela M. Ziskind; Juanita M. Celix; Bradley Peltzer; Merritt W. Brown; Phillip B. Storm; Brian Litt; Brenda E. Porter

doi:10.3233/PEP-12033

Journal of Pediatric Epilepsy, Inhaltsverzeichnis

Journal of Pediatric Epilepsy 2012; 01(04): 211-219
DOI: 10.3233/PEP-12033

Georg Thieme Verlag KG Stuttgart – New York

Leaving tissue associated with infrequent intracranial EEG seizure onsets is compatible with post-operative seizure freedom

Cyrus Huang

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Eric D. Marsh

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

^bDepartment of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Daniela M. Ziskind

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Juanita M. Celix

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Bradley Peltzer

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Merritt W. Brown

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

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Phillip B. Storm

^cDepartment of Neurosurgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Brian Litt

^bDepartment of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

,

Brenda E. Porter

^aDivision of Pediatric Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

^bDepartment of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

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Abstract

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Abstract

Identify seizure onset electrodes that need to be resected for seizure freedom in children undergoing intracranial electroencephalography recording for treatment of medically refractory epilepsy. All children undergoing intracranial electroencephalography subdural grid electrode placement at the Children’s Hospital of Philadelphia from 2002–2008 were asked to enroll. We utilized intraoperative pictures to determine the location of the electrodes and define the resection cavity. A total of 15 patients had surgical fields that allowed for complete identification of the electrodes over the area of resection. Eight of 15 patients were seizure free after a follow up of 1.7 to 8 yr. Only one seizure-free patient had complete resection of all seizure onset associated tissue. Seizure free patients had resection of 64.1% of the seizure onset electrode associated tissue, compared to 35.2% in the not seizure free patients (P = 0.05). Resection of tissue associated with infrequent seizure onsets did not appear to be important for seizure freedom. Resecting ≥ 90% of the electrodes from the predominant seizure contacts predicted post-operative seizure freedom (P = 0.007). The best predictor of seizure freedom was resecting ≥ 90% of tissue involved in majority of a patient’s seizures. Resection of tissue under infrequent seizure onset electrodes was not necessary for seizure freedom.

Keywords

Epilepsy - epilepsy surgery - cortical dysplasia - neocortical epilepsy - intracranial electroencephalography

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