Delphine Taussig1, Axel Lebas2, Mathilde Chipaux3, Maryvonne Jan4, Martine Fohlen3, Christine Bulteau5, Nathalie Dorison3, Sarah Ferrand-Sorbets3, Olivier Delalande3, Georg Dorfmüller5. 1. Service de neurochirurgie pédiatrique, fondation Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France. Electronic address: delphinetaussig@yahoo.fr. 2. Department of Neurophysiology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France. 3. Service de neurochirurgie pédiatrique, fondation Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France. 4. Centre d'investigation clinique, unité Inserm CIC-CRB 1404, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France. 5. Service de neurochirurgie pédiatrique, fondation Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France; Inserm U1129, "infantile épilepsies and Brain Plasticity", Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France; CEA, Gif-sur-Yvette, France.
Abstract
PURPOSE: SEEG in children has a low morbidity and leads to a good surgical outcome, in particular in younger patients. We analysed, in detail, the SEEG data of patients that were subsequently cured by surgery. METHODS: We selected the 48 children explored between 2009 and 2013 in our centre and surgically cured after SEEG-based resections with at least one-year follow-up. We retrospectively studied demographic and surgical data and paid particular attention to the data acquired during the invasive recording. Moreover, we compared the children younger than 5 years of age (group 1: 17 children) to those older than 5 years of age at the time of exploration (group 2: 31 patients). RESULTS: SEEG was well tolerated. Only one patient had slight intracerebral bleeding seen on the post-operative CT-scan without any clinical consequence and which did not prevent the recording. SEEG explored at least four lobes in 59% of patients, either because of a suspected very widespread epileptogenic zone or because of the lack of a precise hypothesis. Auras were recorded only in group 2 (32% of patients, P=0.0009). Despite these difficulties, SEEG led to tailored resections including multilobar resections in 14% and infralobar resections in 69% of patients. The electrical pattern of seizures had no particularities as compared with adults. Interictal spikes and slow waves outside the resection zone were significantly less frequent in group 1 (P=0.02). In symptomatic epilepsies, the lesion matched the irritative zone in only 11% of patients and the ictal onset zone in 32% respectively. CONCLUSION: Our study confirms the low morbidity of SEEG in children. SEEG can disclose a limited epileptogenic zone. Our data suggest that the epileptic network is less complex in younger patients, which has to be confirmed by a quantitative analysis of SEEG signals.
PURPOSE: SEEG in children has a low morbidity and leads to a good surgical outcome, in particular in younger patients. We analysed, in detail, the SEEG data of patients that were subsequently cured by surgery. METHODS: We selected the 48 children explored between 2009 and 2013 in our centre and surgically cured after SEEG-based resections with at least one-year follow-up. We retrospectively studied demographic and surgical data and paid particular attention to the data acquired during the invasive recording. Moreover, we compared the children younger than 5 years of age (group 1: 17 children) to those older than 5 years of age at the time of exploration (group 2: 31 patients). RESULTS: SEEG was well tolerated. Only one patient had slight intracerebral bleeding seen on the post-operative CT-scan without any clinical consequence and which did not prevent the recording. SEEG explored at least four lobes in 59% of patients, either because of a suspected very widespread epileptogenic zone or because of the lack of a precise hypothesis. Auras were recorded only in group 2 (32% of patients, P=0.0009). Despite these difficulties, SEEG led to tailored resections including multilobar resections in 14% and infralobar resections in 69% of patients. The electrical pattern of seizures had no particularities as compared with adults. Interictal spikes and slow waves outside the resection zone were significantly less frequent in group 1 (P=0.02). In symptomatic epilepsies, the lesion matched the irritative zone in only 11% of patients and the ictal onset zone in 32% respectively. CONCLUSION: Our study confirms the low morbidity of SEEG in children. SEEG can disclose a limited epileptogenic zone. Our data suggest that the epileptic network is less complex in younger patients, which has to be confirmed by a quantitative analysis of SEEG signals.
Authors: Hepzibha Alexander; Kelsey Cobourn; Islam Fayed; Dewi Depositario-Cabacar; Robert F Keating; William D Gaillard; Chima O Oluigbo Journal: Childs Nerv Syst Date: 2019-01-09 Impact factor: 1.475