Epilepsia · 2025
Utility of stereo-electroencephalography in patients with bilateral independent/unclear scalp electroencephalographic seizure onset.
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Soni Aayesha J, Burbano M Claudia, Couper R Grace, Espino Poul H, Perez John A L, Persad Amit, Alorabi Khalid, Nambiar Poornima N, Thurairajah Arun, Diosy David, Jones Michelle-Lee, Marti Ana Suller, MacDougall Keith W, Lau Jonathan C, Steven David A, Burneo Jorge G, Pellegrino Giovanni
Аннотация
OBJECTIVE: This study was undertaken to determine whether bilateral independent or unclear (BI/U) scalp electroencephalographic (EEG) ictal onset patterns may predict the diagnostic yield of stereo-electroencephalography (SEEG) and inform surgical decision-making in patients with focal drug-resistant epilepsy.
METHODS: We conducted a retrospective cohort study of consecutive patients with focal drug-resistant epilepsy and BI/U ictal onset on scalp EEG who underwent SEEG evaluation at our center between January 2012 and December 2024. All patients had undergone noninvasive and invasive presurgical assessments. Surgical outcomes were determined using the Engel classification following at least 1 year of postoperative follow-up. A blinded decision validation substudy was also performed, where the team made decisions regarding SEEG and surgical interventions when patients found to have a single SEEG seizure onset zone (SOZ) were presented. Responses were stratified to inform the added diagnostic value of SEEG.
RESULTS: Of 255 SEEG cases screened, 84 patients (33%) had BI/U ictal onset on scalp EEG. The cohort was 56% female, with a median seizure onset age of 12 years (interquartile range = 6-20); 65.5% had temporal lobe epilepsy (TLE). A single SOZ was identified in 14.3% of cases (TLE: 14.5%, extratemporal: 13.8%). These patients had shorter SEEG recording durations (mean = 11 vs. 15.79 days in those with multifocal SEEG SOZs, p = .009). Curative focal resections were performed in 12% (n = 10), with long-term Engel I outcomes achieved in one patient of the entire cohort (1.2%). Palliative resections occurred in 26% (n = 22), with Engel I outcomes in 7% (n = 6). In 50% of the blinded cases, the epilepsy surgery team reported that they would not have recommended SEEG based on phase I data.
SIGNIFICANCE: In patients with BI/U ictal onset on scalp EEG, the likelihood of identifying a single SEEG SOZ, and subsequently achieving seizure freedom, is low. Scalp EEG ictal onset patterns may aid in triaging candidates for invasive evaluation, informing patients regarding presumed SEEG outcome, and avoiding unnecessary surgical procedures.
METHODS: We conducted a retrospective cohort study of consecutive patients with focal drug-resistant epilepsy and BI/U ictal onset on scalp EEG who underwent SEEG evaluation at our center between January 2012 and December 2024. All patients had undergone noninvasive and invasive presurgical assessments. Surgical outcomes were determined using the Engel classification following at least 1 year of postoperative follow-up. A blinded decision validation substudy was also performed, where the team made decisions regarding SEEG and surgical interventions when patients found to have a single SEEG seizure onset zone (SOZ) were presented. Responses were stratified to inform the added diagnostic value of SEEG.
RESULTS: Of 255 SEEG cases screened, 84 patients (33%) had BI/U ictal onset on scalp EEG. The cohort was 56% female, with a median seizure onset age of 12 years (interquartile range = 6-20); 65.5% had temporal lobe epilepsy (TLE). A single SOZ was identified in 14.3% of cases (TLE: 14.5%, extratemporal: 13.8%). These patients had shorter SEEG recording durations (mean = 11 vs. 15.79 days in those with multifocal SEEG SOZs, p = .009). Curative focal resections were performed in 12% (n = 10), with long-term Engel I outcomes achieved in one patient of the entire cohort (1.2%). Palliative resections occurred in 26% (n = 22), with Engel I outcomes in 7% (n = 6). In 50% of the blinded cases, the epilepsy surgery team reported that they would not have recommended SEEG based on phase I data.
SIGNIFICANCE: In patients with BI/U ictal onset on scalp EEG, the likelihood of identifying a single SEEG SOZ, and subsequently achieving seizure freedom, is low. Scalp EEG ictal onset patterns may aid in triaging candidates for invasive evaluation, informing patients regarding presumed SEEG outcome, and avoiding unnecessary surgical procedures.