Invasive evaluation in children (SEEG vs subdural grids).

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Invasive explorations like SEEG and SDE remain vital for children with focal drug-resistant epilepsy.
• These techniques aid in localizing the epileptogenic zone (EZ) and assessing surgical resection feasibility.

Purpose of the Study:

• To discuss the indications and complementary roles of SEEG and SDE in pediatric epilepsy.
• To highlight pediatric-specific considerations for these invasive procedures.
• To explore future advancements in SEEG and SDE for pediatric patients.

Main Methods:

• Review of stereoelectroencephalography (SEEG) and subdural explorations (SDE) in pediatric focal drug-resistant epilepsy.
• Discussion of age limitations (e.g., bone thickness for SEEG) and complication rates (higher for SDE).
• Analysis of pediatric-specific semiology, functional areas, imaging, and urgent situations influencing technique choice.

Main Results:

• Both SEEG and SDE are feasible in children, with SEEG having age limitations.
• SDE has a higher complication rate compared to SEEG.
• SEEG can be used for thermocoagulation, offering both diagnostic and therapeutic benefits.

Conclusions:

• SEEG and SDE, once considered opposed, are now viewed as complementary in pediatric epilepsy management.
• Pediatric indications differ from adults due to unique semiology, anatomy, and imaging findings.
• Future research should focus on improved non-invasive imaging for SEEG planning and adapting SEEG for infants.