Subdural electrodes in focal epilepsy surgery at a typical academic epilepsy center

William O. Tatum, Jenna B. Dionisio, Fernando Vale Diaz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To assess the use of subdural intracranial EEG (iEEG) on postoperative outcomes at an epilepsy center. Methods: Ninety-one epilepsy patients underwent iEEG. Array design was compared with noninvasive EEG with over 1 year of outcome. Patient demographics, implanted brain sites, electrodes, contacts/site, and surgical location were correlated with outcome. Fisher exact test and logistics regression were used to evaluate significance (P ≤ 0.05). Results: Of ninety-one women, 55 (mean age, 32.3 years; range, 11-60) underwent tailored iEEG. Seventy of ninety-one (76.9%) resections (70% temporal) yielded 24/91 (26.4%) seizure free (SF). Strips (57.1%), grids (5.5%), or both (37.4%) for iEEG use was commonly bilateral (58.2%; 65.3% bitemporal) but did not predict outcome (P ≤ NS). A lesion (28/91) did predict a SF outcome (42.9%). The iEEG localized 45.7% of seizures beyond scalp EEG and changed the localization or lateralization in 75.7% of resected patients. Electrode design, localization, lateralization, and site of resection did not correlate with outcome (P ≤ NS). Overall, iEEG use portended a non-SF outcome (P ≤ 0.0001). Conclusions: The use of iEEG selected 46% additional patients for surgery, yet only 26% became SF. A magnetic resonance imaging lesion predicted a SF or seizure-improved outcome. Although iEEG changed the localization and lateralization of scalp ictal EEG in three quarters of patients, its use was a negative predictor for a favorable outcome. Preoperative counseling should emphasize expectations for seizure reduction in patients requiring iEEG

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJournal of Clinical Neurophysiology
Volume32
Issue number2
DOIs
StatePublished - Apr 4 2015

Fingerprint

Partial Epilepsy
Epilepsy
Electrodes
Seizures
Electroencephalography
Scalp
Electrocorticography
Counseling
Logistic Models
Stroke
Magnetic Resonance Imaging
Demography
Brain

Keywords

  • EEG
  • Epilepsy
  • Intracranial
  • Invasive
  • Seizures
  • Subdural

ASJC Scopus subject areas

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Subdural electrodes in focal epilepsy surgery at a typical academic epilepsy center. / Tatum, William O.; Dionisio, Jenna B.; Vale Diaz, Fernando.

In: Journal of Clinical Neurophysiology, Vol. 32, No. 2, 04.04.2015, p. 139-146.

Research output: Contribution to journalArticle

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abstract = "Purpose: To assess the use of subdural intracranial EEG (iEEG) on postoperative outcomes at an epilepsy center. Methods: Ninety-one epilepsy patients underwent iEEG. Array design was compared with noninvasive EEG with over 1 year of outcome. Patient demographics, implanted brain sites, electrodes, contacts/site, and surgical location were correlated with outcome. Fisher exact test and logistics regression were used to evaluate significance (P ≤ 0.05). Results: Of ninety-one women, 55 (mean age, 32.3 years; range, 11-60) underwent tailored iEEG. Seventy of ninety-one (76.9{\%}) resections (70{\%} temporal) yielded 24/91 (26.4{\%}) seizure free (SF). Strips (57.1{\%}), grids (5.5{\%}), or both (37.4{\%}) for iEEG use was commonly bilateral (58.2{\%}; 65.3{\%} bitemporal) but did not predict outcome (P ≤ NS). A lesion (28/91) did predict a SF outcome (42.9{\%}). The iEEG localized 45.7{\%} of seizures beyond scalp EEG and changed the localization or lateralization in 75.7{\%} of resected patients. Electrode design, localization, lateralization, and site of resection did not correlate with outcome (P ≤ NS). Overall, iEEG use portended a non-SF outcome (P ≤ 0.0001). Conclusions: The use of iEEG selected 46{\%} additional patients for surgery, yet only 26{\%} became SF. A magnetic resonance imaging lesion predicted a SF or seizure-improved outcome. Although iEEG changed the localization and lateralization of scalp ictal EEG in three quarters of patients, its use was a negative predictor for a favorable outcome. Preoperative counseling should emphasize expectations for seizure reduction in patients requiring iEEG",
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