Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?

Clinical article

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  • 1 Departments of Neurology,
  • 2 Pediatrics,
  • 3 Neurosurgery, and
  • 4 Radiology, University of Washington; and Divisions of Pediatric Neurology and Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington
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Object

Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied.

Methods

The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009.

Results

Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square).

Conclusions

Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.

Abbreviations used in this paper:ECoG = electrocorticography; EEG = electroencephalography; pre-ECoG = preresective ECoG; post-EEG = postresective ECoG.

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Contributor Notes

Address correspondence to: Carter D. Wray, M.D., Division of Pediatric Neurology, 707 SW Gaines Street, Mail Code CDRC-P, Portland, Oregon 97239. email: carterwraymd@gmail.com.

Please include this information when citing this paper: DOI: 10.3171/2012.1.PEDS11441.

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