Single-pulse electrical stimulation helps to identify epileptogenic cortex in children

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Single-pulse electrical stimulation (SPES) is effective in identifying epileptogenic cortex in adults.
• Its utility in pediatric populations undergoing intracranial recordings requires further evaluation.

Purpose of the Study:

• To evaluate the usefulness of SPES in a pediatric population during intracranial electroencephalography (EEG) recordings.
• To determine the association between SPES responses, ictal onset zone, lesion boundary, and seizure outcome in children.

Main Methods:

• 35 children undergoing intracranial EEG at two London hospitals were studied.
• Multiple brief electrical stimuli were applied to all available contacts.
• Cortical responses were analyzed for associations with clinical data and surgical outcomes.

Main Results:

• Cortical responses to SPES in children were similar to those observed in adults.
• Delayed and repetitive responses were associated with the ictal onset zone and epileptogenic lesions.
• Complete removal of areas with abnormal SPES responses correlated with good seizure outcomes in 54% of cases.

Conclusions:

• SPES provides valuable information for identifying epileptogenic cortex in pediatric epilepsy surgery assessments.
• This method has the potential to improve surgical outcomes for children with difficult-to-treat epilepsy.