SEEG in a child with focal cortical dysplasia: is it safe?

Case presentation: Male, 6 years old, presenting seizures since the age of 4 and evolving with refractory epilepsy, in use of several medications for focal seizures, including Lacosamide, Cannabidiol, Phenobarbital and Sulthiame. A 24-hour electroencephalogram showed bursts of bilateral sharp waves and focal seizures in front rolandic region, with no adequate localization of the epileptogenic zone. Resonance imaging examination revealed a right lesion compatible with focal cortical dysplasia close to motor strip. Patient was submitted to stereoEEG (SEEG) evaluation, with deep electrodes implanted in the left frontal and rolandic region. After seizures mapping patient was submitted to lesionectomy and became seizure free.

Discussion: SEEG is a technique that is being used to investigate refractory epilepsy in adults for many years. However, there are few reports addressing the utility and safety of the SEEG methodology applied to children. The main age limitation is related to bone thickness and fear of surgical complications. Although surgical strategies can often be defined based on non-invasive diagnostic procedures, and despite the recent advances in this field, an increasing number of more complex cases requires invasive EEG to provide precise information on the localization of the epileptogenic zone, its relationships with eloquent cortex, and the feasibility of a tailored surgical resection.

Final comments: Our data supports current literature that SEEG is a safe and effective method of electrophysiological evaluation in children with refractory epilepsy, with no difference in complication rates when compared with adults.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023