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Use of subdural grids and strip electrodes to identify a seizure focus in children
P D Adelson1, P M Black, J R Madsen
1Department of Neurosurgery, Children's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
Insights
Chronic subdural electroencephalography (EEG) monitoring precisely locates seizure foci in children with intractable epilepsy. This invasive EEG method is safe and aids surgical planning, including motor and speech mapping.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Intractable seizures require precise localization for optimal surgical outcomes.
- Scalp electroencephalography (EEG) may be insufficient for accurate seizure focus identification.
- Chronic subdural invasive EEG monitoring is an advocated alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of chronic subdural invasive EEG monitoring in pediatric patients.
- To assess the utility of this method in precisely localizing seizure foci.
- To determine its role in pre-surgical mapping of critical brain functions.
Main Methods:
- Retrospective review of 31 pediatric patients undergoing chronic subdural EEG monitoring (January 1990 - June 1994).
- Placement of grid and/or strip electrodes to map temporal and/or frontal regions.
- Inclusion of cortical stimulation for speech and somatosensory area localization.
Main Results:
- Twenty of 31 patients proceeded to resective surgery based on monitoring findings.
- Chronic subdural EEG monitoring successfully localized seizure foci in pediatric patients.
- One complication (subdural hematoma) occurred in a patient with prior surgery, indicating a favorable safety profile.
Conclusions:
- Chronic subdural invasive EEG monitoring is a valuable tool for precise seizure focus localization in children.
- The procedure allows for essential motor and speech mapping, aiding surgical planning.
- This modality demonstrates safety and efficacy in the pediatric population requiring epilepsy surgery evaluation.
Abstract:
For patients with intractable seizures, the best surgical outcome is achieved following precise localization of the seizure focus. Scalp EEG monitoring may be insufficient and chronic subdural invasive EEG monitoring has therefore been advocated. At Children's Hospital in Boston, 31 children had chronic subdural monitoring from January 1990 through June 1994. The average age at implantation was 11 years. Most patients (22) had placement of grid electrodes combined with strip electrodes to map temporal and/or frontal regions bilaterally. Twenty of the patients eventually had a resective procedure based on the findings. During monitoring, cortical stimulations were performed to localize speech and somatosensory areas. There was only one complication, a subdural hematoma in a patient who had had previous surgery. Chronic subdural EEG monitoring is helpful in precisely localizing seizure foci in pediatric patients; it also allows motor and speech mapping and appears to be a safe modality in children.