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Updated: Jun 23, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Single-pulse electrical stimulation helps to identify epileptogenic cortex in children
Danny Flanagan1, Antonio Valentín, Jorge J García Seoane
1Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK.
Insights
Single-pulse electrical stimulation (SPES) helps identify the epileptogenic cortex in children undergoing epilepsy surgery. Abnormal responses to SPES correlate with seizure outcomes, improving surgical success.
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.
Purpose:
The usefulness of single-pulse electrical stimulation (SPES) during intracranial recordings was evaluated in a pediatric population. This method is useful in identifying epileptogenic cortex in adult subjects.
Methods:
We studied 35 children who were undergoing intracranial electroencephalography (EEG) recordings from two hospitals (King's College Hospital and Great Ormond Street Hospital for Sick Children, London, United Kingdom). In each patient we studied all available contacts using a series of 10 or more single, brief (1ms) electrical stimuli. The cortical responses were reviewed in detail. The data were examined for associations between response type, ictal onset zone, lesion boundary, and seizure outcome.
Results:
We identified cortical responses to SPES that were similar to those reported in adults. In agreement with previous studies we found that two types of responses ("delayed" and "repetitive" responses) were associated with the ictal onset zone and the area of the presumed epileptogenic lesion. When these responses were present (54% of cases), the removal of the entire area responsible for the abnormal responses to SPES was associated with good outcome.
Conclusion:
Cortical responses to SPES in children provide new and additional information in the investigation of epileptogenic cortex in children during assessment for epilepsy surgery. This may improve the outcome for this difficult but important group.
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