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Utility of Stereoelectroencephalography in Children with Dysembryoplastic Neuroepithelial Tumor and Cortical
Jun T Park1,2, Guadalupe Fernandez Baca Vaca1,2, Jennifer Avery1
1a Epilepsy Center , Cleveland University Hospitals , Cleveland , Ohio.
Insights
Stereoelectroencephalography (SEEG) helps pinpoint seizure origins in children with difficult-to-control epilepsy. This invasive method aids in surgical planning for drug-resistant focal epilepsy, improving patient outcomes.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Uncontrolled pediatric seizures risk cognitive impairment, developmental delay, and SUDEP.
- Stereoelectroencephalography (SEEG), developed in the 1960s, is now a key tool in US epilepsy centers.
- SEEG aids in localizing seizure foci for drug-resistant focal epilepsy.
Purpose of the Study:
- To evaluate the utility of SEEG in pediatric epilepsy surgery.
- To highlight the role of SEEG in identifying the epileptogenic zone (EZ) and eloquent cortex.
- To discuss the risks and benefits of SEEG in children.
Main Methods:
- SEEG involves individually tailored electrode placement based on suspected EZ location.
- Depth electrodes are used for electrical stimulation to map eloquent cortex and EZ.
- Neurodiagnostic technologists play a crucial role in intraoperative and post-implantation monitoring.
Main Results:
- SEEG investigation is beneficial for children with symptomatic epilepsy, often caused by cortical dysplasia or DNET.
- The number of electrodes correlates with intraoperative complication risk, necessitating careful risk-benefit analysis.
- Morbidity associated with SEEG is low but must be considered.
Conclusions:
- SEEG is an essential diagnostic tool for pediatric epilepsy surgery.
- It is particularly valuable for cases involving cortical dysplasia and DNET.
- Informed patient selection and risk assessment are critical for successful SEEG utilization.
Background:
Uncontrolled seizures in children can contribute to irreversible cognitive impairment and developmental delay, in addition to placing them at risk for sudden unexplained death in epileptic patients (SUDEP). Since its introduction at Saint Ann Hospital in Paris in the 1960s, stereoelectroencephalography (SEEG) is increasingly being utilized at epilepsy centers in the United States as an invasive tool to help localize the seizure focus in drug-resistant focal epilepsy.
Indications:
Children with symptomatic epilepsy, commonly due to cortical dysplasia and dysembryoplastic neuroepithelial tumor (DNET), may benefit from SEEG investigation. The arrangement of SEEG electrodes is individually tailored based on the suspected location of the epileptogenic zone (EZ). The implanted depth electrodes are used to electrically stimulate the corresponding cortices to obtain information about the topography of eloquent cortex and EZ. Morbidity: Surgical morbidity in these children undergoing SEEG investigation is low, but not negligible. The number of electrodes directly correlates with the risk of intraoperative complication. Thus a risk and benefit analysis needs to be carefully considered for each patient. Neurodiagnostic technology: Both during and after the SEEG electrode implantation, the intraoperative monitoring and EEG technologists play a vital role in the successful monitoring of the patient.
Conclusion:
SEEG is an important tool in the process of epilepsy surgery in children with symptomatic epilepsy, commonly due to cortical dysplasia and DNET.
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