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Jha R, Chua MMJ, Sarkis R, Tobochnik S, Rolston JD. Predictors of SOZ localization, subsequent surgical intervention, and seizure outcomes in iEEG. Ann Clin Transl Neurol 2024; 11:1787-1797. [PMID: 38831617 PMCID: PMC11251470 DOI: 10.1002/acn3.52084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE A third of the patients who undergo intracranial EEG (iEEG) for seizure-onset zone (SOZ) localization do not proceed to resective surgery for epilepsy, and over half of those who do continue to have seizures following treatment. To better identify candidates who are more likely to see benefits from undergoing iEEG, we investigated preoperative and iEEG peri-operative features associated with the localization of a putative SOZ, undergoing subsequent surgical treatment, and seizure outcomes. METHODS We conducted a retrospective cohort study of consecutive patients who underwent iEEG from 2001 to 2022 at two institutions. Outcomes included SOZ identification, proceeding to surgical treatment (resection vs. neuromodulation), and subsequent seizure freedom. RESULTS We identified 329 unique patients who were followed for a median of 3.9 (IQR:7) years, with a minimum of 2-year follow-up for seizure outcomes analyses. Multivariate analysis identified lateralized and lobar localization on scalp EEG (OR 3.8, p = 0.001) to be associated with SOZ localization. Patients with unilateral localization on scalp EEG (OR 3.0, p = 0.003), unilateral preimplantation hypothesis (OR 3.1, p = 0.001), and lesional preoperative MRI (OR 2.1, p = 0.033) were more likely to undergo resection than neuromodulation. Similarly, a unilateral pre-implantation hypothesis (OR 2.6, p < 0.001) favored seizure freedom, whereas prior neuromodulation (OR 0.3, p = 0.013) decreased the odds. Larger number of preoperative anti-seizure medications (ASMs) did not influence seizure freedom rates but did decrease favorable (Engel I, II) seizure outcomes (OR 0.7, p = 0.026). INTERPRETATION Non-invasive localization data prior to iEEG are associated with subsequent resection and seizure freedom, independent of iEEG localization. Factors predictive of SOZ localization are not necessarily predictive of post-operative seizure freedom.
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Affiliation(s)
- Rohan Jha
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Melissa M. J. Chua
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rani Sarkis
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven Tobochnik
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - John D. Rolston
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Chari A, Adler S, Wagstyl K, Seunarine K, Tahir MZ, Moeller F, Thornton R, Boyd S, Das K, Cooray G, Smith S, D'Arco F, Baldeweg T, Eltze C, Cross JH, Tisdall MM. Lesion detection in epilepsy surgery: Lessons from a prospective evaluation of a machine learning algorithm. Dev Med Child Neurol 2024; 66:216-225. [PMID: 37559345 DOI: 10.1111/dmcn.15727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/11/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Abstract
AIM To evaluate a lesion detection algorithm designed to detect focal cortical dysplasia (FCD) in children undergoing stereoelectroencephalography (SEEG) as part of their presurgical evaluation for drug-resistant epilepsy. METHOD This was a prospective, single-arm, interventional study (Idea, Development, Exploration, Assessment, and Long-Term Follow-Up phase 1/2a). After routine SEEG planning, structural magnetic resonance imaging sequences were run through an FCD lesion detection algorithm to identify putative clusters. If the top three clusters were not already sampled, up to three additional SEEG electrodes were added. The primary outcome measure was the proportion of patients who had additional electrode contacts in the SEEG-defined seizure-onset zone (SOZ). RESULTS Twenty patients (median age 12 years, range 4-18 years) were enrolled, one of whom did not undergo SEEG. Additional electrode contacts were part of the SOZ in 1 out of 19 patients while 3 out of 19 patients had clusters that were part of the SOZ but they were already implanted. A total of 16 additional electrodes were implanted in nine patients and there were no adverse events from the additional electrodes. INTERPRETATION We demonstrate early-stage prospective clinical validation of a machine learning lesion detection algorithm used to aid the identification of the SOZ in children undergoing SEEG. We share key lessons learnt from this evaluation and emphasize the importance of robust prospective evaluation before routine clinical adoption of such algorithms. WHAT THIS PAPER ADDS The focal cortical dysplasia detection algorithm collocated with the seizure-onset zone (SOZ) in 4 out of 19 patients. The algorithm changed the resection boundaries in 1 of 19 patients undergoing stereoelectroencephalography for drug-resistant epilepsy. The patient with an altered resection due to the algorithm was seizure-free 1 year after resective surgery. Overall, the algorithm did not increase the proportion of patients in whom SOZ was identified.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
| | - Sophie Adler
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
| | - Konrad Wagstyl
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Kiran Seunarine
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | | | - Rachel Thornton
- Department of Neurophysiology, Addenbrooke's Hospital, Cambridge, UK
| | - Steward Boyd
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | - Krishna Das
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Gerald Cooray
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | - Stuart Smith
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | - Felice D'Arco
- Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Torsten Baldeweg
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
| | - Christin Eltze
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - J Helen Cross
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Martin M Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neuroscience, Institute of Child Health, University College London, London, UK
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Proportion of resected seizure onset zone contacts in pediatric stereo-EEG-guided resective surgery does not correlate with outcome. Clin Neurophysiol 2022; 138:18-24. [DOI: 10.1016/j.clinph.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/21/2022]
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Kassiri J, Elliott C, Liu N, Narvacan K, Wheatly M, Sinclair D. Safety and Efficacy of Stereoelectroencephalography in Pediatric Epilepsy Surgery. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1743192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractStereoelectroencephalography (SEEG) is the preoperative assessment of choice when the epileptogenic zone (EZ) is unclear in patients requiring surgery for severe, drug-refractory epilepsy. There are relatively little data on the safety and efficacy of SEEG in the pediatric epilepsy population. We, therefore, investigated the insertional complications, rate of successful identification of the EZ, and long-term seizure outcomes following surgery after SEEG in children. This was a retrospective study of drug-resistant pediatric epilepsy patients treated with surgery between 2005 and 2020 and who underwent presurgical SEEG. Rationale for and coverage of SEEG, identification of the EZ, and ultimate seizure outcome following SEEG-tailored resections were collected and analyzed. Thirty patients (15 male, mean age: 12.4 ± 5 years) who underwent SEEG were studied. SEEG-related complications occurred in one case (3%). A total of 190 multicontact electrodes (mean: 7.0 ± 2.5 per patient) were implanted across 30 insertions capturing 440 electrographic seizures (mean: 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal magnetic resonance imaging with surface EEG that failed to identify the EZ (17/30; 57%). SEEG identified a putative EZ in all cases, resulting in SEEG-tailored resections in 25/30 (83%). Freedom from disabling seizures was achieved following resections in 20/25 cases (80%) with 5.9 ± 4.0 years of postoperative follow-up. SEEG is a safe and effective way to identify the EZ in the presurgical evaluation of children with refractory epilepsy and permits effective and long-lasting SEEG-tailored resections.
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Affiliation(s)
- Janani Kassiri
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cameron Elliott
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Natarie Liu
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
| | - Karl Narvacan
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wheatly
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - D.Barry Sinclair
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
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Almojuela A, Xu Q, O'Carroll A, MacDonald C, Ritchie L, Serletis D. Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1742607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background A Pediatric Epilepsy Program was instituted in Manitoba in 2016. This report seeks to describe changes in the management of pediatric epilepsy patients in Manitoba since the inception of this Program, to provide an early analysis of local outcomes, and to present a framework for further program development.
Methods Data was collected for patients treated both before and after inception of the Program. Caregivers completed questionnaires on quality of life and program satisfaction. An online database was created to capture demographic information, seizure and quality of life outcomes, and caregiver satisfaction ratings. Descriptive statistics were used to summarize the results.
Results Prior to commencement of the Program, 16 patients underwent vagal nerve stimulator (VNS) insertion. At last follow-up, 6.25% of patients achieved Engel class I outcome, 75% achieved class III outcome, and 18.75% were classified as class IV. Following inception of the Program, 11 patients underwent resective procedures and 3 underwent VNS insertions. At last follow-up, 78.6% of patients achieved Engel class I outcome, 14.3% achieved class III outcome, and 7.1% were classified as class IV. Since inception of the Program, the average Quality of Life in Childhood Epilepsy Questionnaire-55 score measuring patient quality of life was (59.7 ± 23.2)/100. The average Care-Related Quality of Life-7D score measuring caregiver quality of life was (78.3 ± 18.6)/100. Caregiver satisfaction had an average rating of (9.4 ± 0.8)/10.
Conclusion Access to epilepsy surgery has significantly improved for children in Manitoba and has led to favorable, early multidimensional outcomes. Structural organization, funding, and multidisciplinary engagement are necessary for program sustainability and growth.
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Affiliation(s)
- Alysa Almojuela
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Aoife O'Carroll
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Carling MacDonald
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Demitre Serletis
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States
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