Escaping the Procrustean Bed: A Perspective on Pediatric Stereoelectroencephalography

Area of Science:

• Neurology
• Pediatric Epilepsy Surgery

Background:

• Refractory epilepsy in children presents unique challenges.
• Advances in noninvasive testing have not significantly improved epilepsy surgery outcomes.

Purpose of the Study:

• To highlight the special considerations and limitations of stereoelectroencephalography (SEEG) in pediatric refractory epilepsy.
• To emphasize the importance of an individualized approach for successful pediatric epilepsy surgery.

Main Methods:

• Stereoelectroencephalography (SEEG) as a hypothesis-driven investigation method.
• Analysis of pediatric-specific factors including etiology, epilepsy syndromes, maturation, and neural plasticity.
• Consideration of age-related characteristics in semiology and electrophysiology.

Main Results:

• SEEG enables tailored surgical interventions, potentially leading to seizure freedom with minimal functional deficit.
• Understanding unique pediatric aspects like ontogeny of semiology and electrophysiology is vital.
• Cortical stimulation in children requires special considerations.

Conclusions:

• Stereoelectroencephalography is an established method for investigating pediatric refractory epilepsy.
• A personalized, individualized approach to SEEG is key for successful pediatric epilepsy surgery.
• A "SEEG way of thinking" and mentorship may improve surgical outcomes.