Utility of invasive electroencephalography in children 3 years old and younger with refractory epilepsy

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  • 1 Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York;
  • 2 Montefiore Medical Center, New York, New York; and
  • 3 Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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OBJECTIVE

Early surgical intervention for pediatric refractory epilepsy is increasingly advocated as surgery has become safer and data have demonstrated improved outcomes with early seizure control. There is concern that the risks associated with staged invasive electroencephalography (EEG) in very young children outweigh the potential benefits. Here, the authors present a cohort of children with refractory epilepsy who were referred for invasive monitoring, and they evaluate the role and safety of staged invasive EEG in those 3 years old and younger.

METHODS

The authors conducted a retrospective review of children 3 years and younger with epilepsy, who had been managed surgically at two institutions between 2001 and 2015. A cohort of pediatric patients older than 3 years of age was used for comparison. Demographics, seizure etiology, surgical management, surgical complications, and adverse events were recorded. Statistical analysis was completed using Stata version 13. A p < 0.05 was considered statistically significant. Fisher’s exact test was used to compare proportions.

RESULTS

Ninety-four patients (45 patients aged ≤ 3 [47.9%]) and 208 procedures were included for analysis. Eighty-six procedures (41.3%) were performed in children younger than 3 years versus 122 in the older cohort (58.7%). Forty-two patients underwent grid placement (14 patients aged ≤ 3 [33.3%]); 3 of them developed complications associated with the implant (3/42 [7.14%]), none of whom were among the younger cohort. Across all procedures, 11 complications occurred in the younger cohort versus 5 in the older patients (11/86 [12.8%] vs 5/122 [4.1%], p = 0.032). Two adverse events occurred in the younger group versus 1 in the older group (2/86 [2.32%] vs 1/122 [0.82%], p = 0.571). Following grid placement, 13/14 younger patients underwent guided resections compared to 20/28 older patients (92.9% vs 71.4%, p = 0.23).

CONCLUSIONS

While overall complication rates were higher in the younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. Invasive electrocorticography informs management in very young children with refractory, localization-related epilepsy and should therefore be used when clinically indicated.

ABBREVIATIONS EEG = electroencephalography; SEEG = stereo-EEG.

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Contributor Notes

Correspondence Caitlin E. Hoffman: Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, NY. ceh2003@med.cornell.edu.

INCLUDE WHEN CITING Published online September 18, 2020; DOI: 10.3171/2020.6.PEDS19504.

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

    Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia. 1975;16(1):166.

  • 2

    Walker MC, Sander JW. Difficulties in extrapolating from clinical trial data to clinical practice: the case of antiepileptic drugs. Neurology. 1997;49(2):333337.

    • Search Google Scholar
    • Export Citation
  • 3

    Keene DL, Loy-English I, Ventureyra EC. Long-term socioeconomic outcome following surgical intervention in the treatment of refractory epilepsy in childhood and adolescence. Childs Nerv Syst. 1998;14(8):362365.

    • Search Google Scholar
    • Export Citation
  • 4

    Kumar RM, Koh S, Knupp K, Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy. Childs Nerv Syst. 2015;31(9):14791491.

    • Search Google Scholar
    • Export Citation
  • 5

    Loddenkemper T, Holland KD, Stanford LD, Developmental outcome after epilepsy surgery in infancy. Pediatrics. 2007;119(5):930935.

  • 6

    Wirrell E, Wong-Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population-based study. Epilepsia. 2012;53(9):15631569.

    • Search Google Scholar
    • Export Citation
  • 7

    Bittar RG, Rosenfeld JV, Klug GL, Resective surgery in infants and young children with intractable epilepsy. J Clin Neurosci. 2002;9(2):142146.

    • Search Google Scholar
    • Export Citation
  • 8

    Duchowny M, Jayakar P, Resnick T, Epilepsy surgery in the first three years of life. Epilepsia. 1998;39(7):737743.

  • 9

    Bromley RL, Leeman BA, Baker GA, Meador KJ. Cognitive and neurodevelopmental effects of antiepileptic drugs. Epilepsy Behav. 2011;22(1):916.

    • Search Google Scholar
    • Export Citation
  • 10

    Holmes GL. The 2008 Judith Hoyer lecture: epilepsy in children: listening to mothers. Epilepsy Behav. 2009;16(2):193202.

  • 11

    Wiebe S. Early epilepsy surgery. Curr Neurol Neurosci Rep. 2004;4(4):315320.

  • 12

    Schmidt D, Stavem K. Long-term seizure outcome of surgery versus no surgery for drug-resistant partial epilepsy: a review of controlled studies. Epilepsia. 2009;50(6):13011309.

    • Search Google Scholar
    • Export Citation
  • 13

    Téllez-Zenteno JF, Hernández Ronquillo L, Moien-Afshari F, Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res. 2010;89(2-3):310318.

    • Search Google Scholar
    • Export Citation
  • 14

    Kilpatrick C, Cook M, Kaye A, Non-invasive investigations successfully select patients for temporal lobe surgery. J Neurol Neurosurg Psychiatry. 1997;63(3):327333.

    • Search Google Scholar
    • Export Citation
  • 15

    Thadani VM, Williamson PD, Berger R, Successful epilepsy surgery without intracranial EEG recording: criteria for patient selection. Epilepsia. 1995;36(1):715.

    • Search Google Scholar
    • Export Citation
  • 16

    Minassian BA, Otsubo H, Weiss S, Magnetoencephalographic localization in pediatric epilepsy surgery: comparison with invasive intracranial electroencephalography. Ann Neurol. 1999;46(4):627633.

    • Search Google Scholar
    • Export Citation
  • 17

    Nair DR, Burgess R, McIntyre CC, Lüders H. Chronic subdural electrodes in the management of epilepsy. Clin Neurophysiol. 2008;119(1):1128.

    • Search Google Scholar
    • Export Citation
  • 18

    Nickels KC, Wong-Kisiel LC, Moseley BD, Wirrell EC. Temporal lobe epilepsy in children. Epilepsy Res Treat. 2012;2012:849540.

  • 19

    Van Gompel JJ, Worrell GA, Bell ML, Intracranial electroencephalography with subdural grid electrodes: techniques, complications, and outcomes. Neurosurgery. 2008;63(3):498506.

    • Search Google Scholar
    • Export Citation
  • 20

    Wellmer J, von der Groeben F, Klarmann U, Risks and benefits of invasive epilepsy surgery workup with implanted subdural and depth electrodes. Epilepsia. 2012;53(8):13221332.

    • Search Google Scholar
    • Export Citation
  • 21

    Yang PF, Zhang HJ, Pei JS, Intracranial electroencephalography with subdural and/or depth electrodes in children with epilepsy: techniques, complications, and outcomes. Epilepsy Res. 2014;108(9):16621670.

    • Search Google Scholar
    • Export Citation
  • 22

    Adelson PD, Black PM, Madsen JR, Use of subdural grids and strip electrodes to identify a seizure focus in children. Pediatr Neurosurg. 1995;22(4):174180.

    • Search Google Scholar
    • Export Citation
  • 23

    Johnston JM Jr, Mangano FT, Ojemann JG, Complications of invasive subdural electrode monitoring at St. Louis Children’s Hospital, 1994-2005. J Neurosurg. 2006;105(5)(suppl):343347.

    • Search Google Scholar
    • Export Citation
  • 24

    Onal C, Otsubo H, Araki T, Complications of invasive subdural grid monitoring in children with epilepsy. J Neurosurg. 2003;98(5):10171026.

    • Search Google Scholar
    • Export Citation
  • 25

    Musleh W, Yassari R, Hecox K, Low incidence of subdural grid-related complications in prolonged pediatric EEG monitoring. Pediatr Neurosurg. 2006;42(5):284287.

    • Search Google Scholar
    • Export Citation
  • 26

    Jayakar P, Duchowny M, Resnick TJ. Subdural monitoring in the evaluation of children for epilepsy surgery. J Child Neurol. 1994;9(suppl 2):6166.

    • Search Google Scholar
    • Export Citation
  • 27

    Gowda S, Salazar F, Bingaman WE, Surgery for catastrophic epilepsy in infants 6 months of age and younger. J Neurosurg Pediatr. 2010;5(6):603607.

    • Search Google Scholar
    • Export Citation
  • 28

    Taussig D, Dorfmüller G, Fohlen M, Invasive explorations in children younger than 3 years. Seizure. 2012;21(8):631638.

  • 29

    Abou-Al-Shaar H, Brock AA, Kundu B, Increased nationwide use of stereoencephalography for intracranial epilepsy electroencephalography recordings. J Clin Neurosci. 2018;53:132134.

    • Search Google Scholar
    • Export Citation
  • 30

    Taussig D, Chipaux M, Fohlen M, Invasive evaluation in children (SEEG vs subdural grids). Seizure. 2020;77:4351.

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