Lara Jehi1, Marcia Morita-Sherman1, Thomas E Love2, Fabrice Bartolomei3, William Bingaman1, Kees Braun4, Robyn M Busch1, John Duncan5, Walter J Hader6, Guoming Luan7, John D Rolston8, Stephan Schuele9, Laura Tassi10, Sumeet Vadera11, Shehryar Sheikh1, Imad Najm1, Amir Arain12, Justin Bingaman1, Beate Diehl5, Jane de Tisi5, Matea Rados4, Pieter Van Eijsden4, Sandra Wahby6, Xiongfei Wang7, Samuel Wiebe6. 1. Cleveland Clinic Epilepsy Center, Cleveland, OH. 2. Departments of Medicine and Population & Quantitative Health Sciences, CWRU and Population Health Research Institute, The MetroHealth System, and Center for Health Care Research and Policy, CWRU - MetroHealth, Cleveland, OH. 3. Epileptology Department, Aix Marseille University, APHM, INSERM, INS, Institut National de la Sante et de la Recherche Medicale, Timone Hospital, Marseille, France. 4. Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands. 5. Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK. 6. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 7. Department of Neurosurgery, Comprehensive Epilepsy Center, Sanbo Brain Hospital, Capital Medical University; Beijing Key Laboratory of Epilepsy; Epilepsy Institution, Beijing Institute for Brain Disorders, Beijing, China. 8. Department of Neurosurgery, University of Utah, Salt Lake City, UT. 9. Department of Neurology, Northwestern University, Chicago, IL. 10. "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milano, Italy. 11. Department of Neurosurgery, University of California, Irvine, CA. 12. Department of Neurology, University of Utah, Salt Lake City, UT.
Abstract
OBJECTIVE: The aim was to compare the outcomes of subdural electrode (SDE) implantations versus stereotactic electroencephalography (SEEG), the 2 predominant methods of intracranial electroencephalography (iEEG) performed in difficult-to-localize drug-resistant focal epilepsy. METHODS: The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005 and 2019 with ≥1 year of follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints were: (1) likelihood of resection after iEEG; (2) seizure freedom at last follow-up; and (3) complications (composite of postoperative infection, symptomatic intracranial hemorrhage, or permanent neurological deficit). RESULTS: Ten study sites from 7 countries and 3 continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE and 942 SEEG), of whom 988 (67%) underwent subsequent resection. Propensity score matching improved covariate balance between exposure groups for all analyses. Propensity-matched patients who underwent SDE had higher odds of subsequent resective surgery (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.05, 1.84) and higher odds of complications (OR = 2.24, 95% CI 1.34, 3.74; unadjusted: 9.6% after SDE vs 3.3% after SEEG). Odds of seizure freedom in propensity-matched resected patients were 1.66 times higher (95% CI 1.21, 2.26) for SEEG compared with SDE (unadjusted: 55% seizure free after SEEG-guided resections vs 41% after SDE). INTERPRETATION: In comparison to SEEG, SDE evaluations are more likely to lead to brain surgery in patients with drug-resistant epilepsy but have more surgical complications and lower probability of seizure freedom. This comparative-effectiveness study provides the highest feasible evidence level to guide decisions on iEEG. ANN NEUROL 2021;90:927-939.
OBJECTIVE: The aim was to compare the outcomes of subdural electrode (SDE) implantations versus stereotactic electroencephalography (SEEG), the 2 predominant methods of intracranial electroencephalography (iEEG) performed in difficult-to-localize drug-resistant focal epilepsy. METHODS: The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005 and 2019 with ≥1 year of follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints were: (1) likelihood of resection after iEEG; (2) seizure freedom at last follow-up; and (3) complications (composite of postoperative infection, symptomatic intracranial hemorrhage, or permanent neurological deficit). RESULTS: Ten study sites from 7 countries and 3 continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE and 942 SEEG), of whom 988 (67%) underwent subsequent resection. Propensity score matching improved covariate balance between exposure groups for all analyses. Propensity-matched patients who underwent SDE had higher odds of subsequent resective surgery (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.05, 1.84) and higher odds of complications (OR = 2.24, 95% CI 1.34, 3.74; unadjusted: 9.6% after SDE vs 3.3% after SEEG). Odds of seizure freedom in propensity-matched resected patients were 1.66 times higher (95% CI 1.21, 2.26) for SEEG compared with SDE (unadjusted: 55% seizure free after SEEG-guided resections vs 41% after SDE). INTERPRETATION: In comparison to SEEG, SDE evaluations are more likely to lead to brain surgery in patients with drug-resistant epilepsy but have more surgical complications and lower probability of seizure freedom. This comparative-effectiveness study provides the highest feasible evidence level to guide decisions on iEEG. ANN NEUROL 2021;90:927-939.
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