Utility of invasive electroencephalography in children 3 years old and younger with refractory epilepsy
Rafael Uribe-Cardenas1, Andre E Boyke2, Justin T Schwarz1
11Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York.
Insights
Staged invasive electroencephalography (EEG) is safe for children under 3 with refractory epilepsy. While overall complication rates were higher in this young group, subdural grid placement showed no increased risk, supporting its use when indicated.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Early surgical intervention for pediatric refractory epilepsy is gaining traction due to improved surgical safety and outcomes.
- Concerns exist regarding the risks of staged invasive electroencephalography (EEG) in very young children (≤3 years).
Purpose of the Study:
- To evaluate the role and safety of staged invasive EEG in children aged 3 years and younger with refractory epilepsy.
- To compare complication rates and outcomes between younger (≤3 years) and older pediatric epilepsy patients undergoing invasive monitoring.
Main Methods:
- Retrospective review of pediatric patients with epilepsy undergoing surgical management between 2001 and 2015.
- Inclusion of patients aged 3 years and younger, with a comparison cohort of older pediatric patients.
- Analysis of demographics, seizure etiology, surgical management, complications, and adverse events using Fisher's exact test.
Main Results:
- Ninety-four patients (45 aged ≤3 years) and 208 procedures were analyzed; 86 procedures in the younger cohort (41.3%).
- Overall complication rates were higher in the younger cohort (12.8%) compared to the older cohort (4.1%, p=0.032).
- Subdural grid placement complications occurred in 7.14% of patients, with none in the younger cohort.
Conclusions:
- Subdural grid placement was not associated with increased surgical complications in children aged 3 years and younger.
- Invasive electrocorticography is valuable for managing refractory, localization-related epilepsy in very young children.
- Staged invasive EEG should be utilized when clinically indicated for pediatric refractory epilepsy, even in the youngest patients.
Objective:
Early surgical intervention for pediatric refractory epilepsy is increasingly advocated as surgery has become safer and data have demonstrated improved outcomes with early seizure control. There is concern that the risks associated with staged invasive electroencephalography (EEG) in very young children outweigh the potential benefits. Here, the authors present a cohort of children with refractory epilepsy who were referred for invasive monitoring, and they evaluate the role and safety of staged invasive EEG in those 3 years old and younger.
Methods:
The authors conducted a retrospective review of children 3 years and younger with epilepsy, who had been managed surgically at two institutions between 2001 and 2015. A cohort of pediatric patients older than 3 years of age was used for comparison. Demographics, seizure etiology, surgical management, surgical complications, and adverse events were recorded. Statistical analysis was completed using Stata version 13. A p < 0.05 was considered statistically significant. Fisher's exact test was used to compare proportions.
Results:
Ninety-four patients (45 patients aged ≤ 3 [47.9%]) and 208 procedures were included for analysis. Eighty-six procedures (41.3%) were performed in children younger than 3 years versus 122 in the older cohort (58.7%). Forty-two patients underwent grid placement (14 patients aged ≤ 3 [33.3%]); 3 of them developed complications associated with the implant (3/42 [7.14%]), none of whom were among the younger cohort. Across all procedures, 11 complications occurred in the younger cohort versus 5 in the older patients (11/86 [12.8%] vs 5/122 [4.1%], p = 0.032). Two adverse events occurred in the younger group versus 1 in the older group (2/86 [2.32%] vs 1/122 [0.82%], p = 0.571). Following grid placement, 13/14 younger patients underwent guided resections compared to 20/28 older patients (92.9% vs 71.4%, p = 0.23).
Conclusions:
While overall complication rates were higher in the younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. Invasive electrocorticography informs management in very young children with refractory, localization-related epilepsy and should therefore be used when clinically indicated.
