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Updated: Nov 19, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Focal polymicrogyria in children: Contribution of invasive explorations and epileptogenicity mapping in the surgical
Claudine Sculier1, Delphine Taussig2, Olivier David3
1Département de Neurologie pédiatrique, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium.
Insights
Invasive EEG and epileptogenicity mapping help assess pediatric epilepsy in focal polymicrogyria patients. Surgical outcomes varied, highlighting the complexity of this condition.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Epileptology
Background:
- Focal polymicrogyria (PMG) can cause refractory epilepsy in children.
- Assessing surgical candidacy requires precise localization of the epileptogenic zone (EZ).
- Invasive electroencephalography (iEEG) and epileptogenicity mapping (EM) are advanced tools for EZ localization.
Purpose of the Study:
- To evaluate the contribution of iEEG and EM in pediatric patients with focal PMG-related epilepsy.
- To assess surgical outcomes in this cohort.
Main Methods:
- Retrospective case series of 8 pediatric patients with focal PMG and refractory epilepsy.
- Inclusion of stereoelectroencephalography (SEEG) and/or subdural exploration (SDE).
- Analysis of clinical data, MRI, iEEG visual analysis, and time-frequency analysis for EM.
Main Results:
- The EZ showed variable concordance with the PMG lesion (concordant in 1, larger in 3, smaller in 2, different in 1).
- Four patients underwent tailored resective surgery, one had callosotomy.
- Two patients achieved seizure freedom post-surgery; EM refined EZ localization in 4 cases.
Conclusions:
- This is the first pediatric study on iEEG and EM for focal PMG-related epilepsy.
- The study highlights the complexity of EZ-lesion concordance and variable surgical responses.
- iEEG and EM are valuable tools for surgical decision-making in pediatric focal PMG epilepsy.
Objective:
Report of the contribution of invasive EEG (iEEG) and epileptogenicity mappings (EM) in a pediatric cohort of patients with epilepsy associated with focal polymicrogyria (PMG) and candidates for resective surgery.
Method:
Retrospective pediatric case series of patients presenting focal PMG-related refractory epilepsy undergoing an invasive exploration (iEEG) at Fondation Rothschild Hospital. We reviewed clinical data, structural MRI, and visual analysis of iEEG recordings. Moreover, time-frequency analysis of SEEG signals with a neuroimaging approach (epileptogenicity maps) was used to support visual analysis.
Results:
Between 2012 and 2019, eight patients were selected. Five patients were explored with stereoelectroencephalography (SEEG) only, one patient with subdural exploration (SDE) only and two patients first underwent SEEG and then SDE. The mean age at seizure onset was 40.3 months (range 3-120), and the mean age for the iEEG 10.8 years (range 7-15). The epileptogenic zone (EZ) appeared concordant to the PMG lesion in only one case, was larger in three cases, smaller in two cases and different in one case. Four cases were selected for tailored resective surgery and one for total callosotomy. Two patients remained seizure-free at their last follow-up (mean 32.6 months, range 7-98). Epileptogenicity mapping (EM) refined the qualitative analysis, showing in four patients an EZ larger than visually defined.
Conclusion:
This study is the first pediatric study to analyze the value of iEEG and EM as well as operability in focal PMG-related refractory epilepsy. The results illustrate the complexity of this pathology with variable concordance between the EZ and the lesion and mixed response to surgery.
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