Surgically treatable adult epilepsy: a changing patient population. Experience from a level 4 epilepsy center

View More View Less
  • 1 Departments of Neurosurgery and
  • | 2 Neurology, University of Alabama at Birmingham, Alabama
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Invasive monitoring has long been utilized in the evaluation of patients for epilepsy surgery, providing localizing information to guide resection. Stereoelectroencephalography (SEEG) was introduced at the authors’ level 4 epilepsy surgery program in 2013, with responsive neurostimulation (RNS) becoming available the following year. The authors sought to characterize patient demographics and epilepsy-related variables before and after SEEG introduction to understand whether differences emerged in their patient population. This information will be useful in understanding how SEEG, possibly in conjunction with RNS availability, may have changed practice patterns over time.

METHODS

This is a retrospective cohort study of consecutive patients who underwent surgery for epilepsy from 2006 to 2018, comprising 7 years before and 5 years after the introduction of SEEG. The authors performed univariate analyses of patient characteristics and outcomes and used generalized estimating equations logistic regression for predictive analysis.

RESULTS

A total of 178 patients were analyzed, with 109 patients in the pre-SEEG cohort and 69 patients in the post-SEEG cohort. In the post-SEEG cohort, more patients underwent invasive monitoring for suspected bilateral seizure onsets (40.6% vs 22.0%, p = 0.01) and extratemporal seizure onsets (68.1% vs 8.3%, p < 0.0001). The post-SEEG cohort had a higher proportion of patients with seizures arising from eloquent cortex (14.5% vs 0.9%, p < 0.001). Twelve patients underwent RNS insertion in the post-SEEG group versus none in the pre-SEEG group. Fewer patients underwent resection in the post-SEEG group (55.1% vs 96.3%, p < 0.0001), but there was no significant difference in rates of seizure freedom between cohorts for those patients having undergone a follow-up resection (53.1% vs 59.8%, p = 0.44).

CONCLUSIONS

These findings demonstrate that more patients with suspected bilateral, eloquent, or extratemporal epilepsy underwent invasive monitoring after adoption of SEEG. This shift occurred coincident with the adoption of RNS, both of which likely contributed to increased patient complexity. The authors conclude that their practice now considers invasive monitoring for patients who likely would not previously have been candidates for surgical investigation and subsequent intervention.

ABBREVIATIONS

ATL = anterior temporal lobectomy; DBS = deep brain stimulation; FCD = focal cortical dysplasia; HS = hippocampal sclerosis; LITT = laser interstitial thermal therapy; RNS = responsive neurostimulation; SEEG = stereoelectroencephalography; UAB = University of Alabama at Birmingham.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Jacob R. Lepard: University of Alabama at Birmingham, AL. jlepard@uabmc.edu.

INCLUDE WHEN CITING Published online May 28, 2021; DOI: 10.3171/2020.10.JNS201629.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Gonzalez-Giraldo E, Sullivan JE. Advances in the treatment of drug-resistant pediatric epilepsy. Semin Neurol. 2020;40(2):257262.

  • 2

    Gonzalez-Martinez J, Bulacio J, Alexopoulos A, et al. . Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia. 2013;54(2):323330.

    • Search Google Scholar
    • Export Citation
  • 3

    Geller EB, Skarpaas TL, Gross RE, et al. . Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia. 2017;58(6):9941004.

    • Search Google Scholar
    • Export Citation
  • 4

    Zhou JJ, Chen T, Farber SH, et al. . Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present). Neurosurg Focus. 2018;45(2):E5.

    • Search Google Scholar
    • Export Citation
  • 5

    Klinger N, Mittal S. Deep brain stimulation for seizure control in drug-resistant epilepsy. Neurosurg Focus. 2018;45(2):E4.

  • 6

    Bezchlibnyk YB, Willie JT, Gross RE. A neurosurgeon’s view: Laser interstitial thermal therapy of mesial temporal lobe structures. Epilepsy Res. 2018;142:135139.

    • Search Google Scholar
    • Export Citation
  • 7

    Wicks RT, Jermakowicz WJ, Jagid JR, et al. . Laser interstitial thermal therapy for mesial temporal lobe epilepsy. Neurosurgery. 2016;79(suppl 1):S83S91.

    • Search Google Scholar
    • Export Citation
  • 8

    Kahane P, Bartolomei F. Temporal lobe epilepsy and hippocampal sclerosis: lessons from depth EEG recordings. Epilepsia. 2010;51(suppl 1):5962.

    • Search Google Scholar
    • Export Citation
  • 9

    Obaid S, Zerouali Y, Nguyen DK. Insular epilepsy: semiology and noninvasive investigations. J Clin Neurophysiol. 2017;34(4):315323.

  • 10

    Miocinovic S, Somayajula S, Chitnis S, Vitek JL. History, applications, and mechanisms of deep brain stimulation. JAMA Neurol. 2013;70(2):163171.

    • Search Google Scholar
    • Export Citation
  • 11

    Wali AR, Park CC, Santiago-Dieppa DR, et al. . Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis. Neurosurg Focus. 2017;42(6):E6.

    • Search Google Scholar
    • Export Citation
  • 12

    Winkler EA, Yue JK, Deng H, et al. . National trends in cerebral bypass surgery in the United States, 2002–2014. Neurosurg Focus. 2019;46(2):E4.

    • Search Google Scholar
    • Export Citation
  • 13

    Albe Fessard D, Arfel G, Guiot G, et al. . Characteristic electric activities of some cerebral structures in man. Article in French. Ann Chir. 1963;17:11851214.

    • Search Google Scholar
    • Export Citation
  • 14

    Benabid AL, Pollak P, Louveau A, et al. . Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50(1-6):344346.

    • Search Google Scholar
    • Export Citation
  • 15

    Fransen PSS, Beumer D, Berkhemer OA, et al. . MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343.

    • Search Google Scholar
    • Export Citation
  • 16

    Goyal M, Menon BK, van Zwam WH, et al. . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):17231731.

    • Search Google Scholar
    • Export Citation
  • 17

    Jovin TG, Saver JL, Ribo M, et al. . Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017;12(6):641652.

    • Search Google Scholar
    • Export Citation
  • 18

    Bourdillon P, Ryvlin P, Isnard J, et al. . Stereotactic electroencephalography is a safe procedure, including for insular implantations. World Neurosurg. 2017;99:353361.

    • Search Google Scholar
    • Export Citation
  • 19

    Cardinale F, Cossu M, Castana L, et al. . Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery. 2013;72(3):353366.

    • Search Google Scholar
    • Export Citation
  • 20

    Mullin JP, Shriver M, Alomar S, et al. . Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia. 2016;57(3):386401.

    • Search Google Scholar
    • Export Citation
  • 21

    Mullin JP, Sexton D, Al-Omar S, et al. . Outcomes of subdural grid electrode monitoring in the stereoelectroencephalography era. World Neurosurg. 2016;89:255258.

    • Search Google Scholar
    • Export Citation
  • 22

    González-Martínez J, Bulacio J, Thompson S, et al. . Technique, results, and complications related to robot-assisted stereoelectroencephalography. Neurosurgery. 2016;78(2):169180.

    • Search Google Scholar
    • Export Citation
  • 23

    Gonzalez-Martinez J, Mullin J, Bulacio J, et al. . Stereoelectroencephalography in children and adolescents with difficult-to-localize refractory focal epilepsy. Neurosurgery. 2014;75(3):258268.

    • Search Google Scholar
    • Export Citation
  • 24

    McGovern RA, Knight EP, Gupta A, et al. . Robot-assisted stereoelectroencephalography in children. J Neurosurg Pediatr. 2018;23(3):288296.

  • 25

    Asadi-Pooya AA, Stewart GR, Abrams DJ, Sharan A. Prevalence and incidence of drug-resistant mesial temporal lobe epilepsy in the United States. World Neurosurg. 2017;99:662666.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 266 266 266
Full Text Views 29 29 29
PDF Downloads 42 42 42
EPUB Downloads 0 0 0