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Chan AY, Lien BV, Brown NJ, Gendreau J, Beyer RS, Yang CY, Choi EH, Hsu FP, Vadera S. Utility of adding electrodes in patients undergoing invasive seizure localization: A case series. Ann Med Surg (Lond) 2022; 80:104139. [PMID: 35846863 PMCID: PMC9284396 DOI: 10.1016/j.amsu.2022.104139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Surgery can be an effective treatment for epilepsy if the seizure onset is adequately localized. Invasive monitoring is used if noninvasive methods are inconclusive. Initial invasive monitoring may fail if the pre-surgical hypothesis regarding location of epileptic foci is wrong. At this point, a decision must be made whether to remove all electrodes without a clearly defined location of onset or to implant additional electrodes with the aim of achieving localization by expanding coverage. Methods Electrodes were placed according to a hypothesis derived from noninvasive monitoring techniques in adult patients with long term epilepsy. Seizure onset was not clearly localized at the end of the invasive monitoring period in ten patients, and additional electrodes were placed based on a new hypothesis that incorporated data from the invasive monitoring period. Results Successful localization was achieved in nine patients. There were no complications with adding additional electrodes. At final follow up, four patients were seizure free while four others had at least a 50% reduction in seizures after undergoing surgical intervention. Conclusion Seizure foci were localized safely in 90% of adult patients with long term epilepsy after implanting additional electrodes and expanding coverage. Patients undergoing invasive monitoring without clear localization should have additional electrodes placed to expand monitoring coverage as it is safe and effective.
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Affiliation(s)
- Alvin Y. Chan
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
- Corresponding author. Department of Neurological Surgery, University of California, Irvine 200 S. Manchester Avenue, Suite 201, Orange, CA, 92868, United States.
| | - Brian V. Lien
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Nolan J. Brown
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, 3400 North Charles Street, Baltimore, MD, 21218, United States
| | - Ryan S. Beyer
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Elliot H. Choi
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Frank P.K. Hsu
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
| | - Sumeet Vadera
- Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States
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