Stereoelectroencephalography versus subdural electrodes for invasive monitoring of drug-resistant epilepsy patients: a systematic review and meta-analysis.

INTRODUCTION

Invasive monitoring for epilepsy surgery is critical for localizing epileptogenic zones. Stereoelectroencephalography (SEEG) and subdural electrodes (SDE) are two primary techniques used for this purpose. This meta-analysis aims to compare the effectiveness and safety of SEEG and SDE regarding various clinical outcomes in patients undergoing invasive epilepsy monitoring.

METHODS

We conducted a systematic review and meta-analysis of studies comparing SEEG and SDE for invasive epilepsy monitoring. PubMed, Embase, and Cochrane Library databases were searched for relevant studies. Two reviewers performed data extraction and quality assessment through Cochrane's ROBINS-I tool independently. Statistical analyses were conducted using a random-effects model in R Studio.

RESULTS

A total of 16 studies involving 3751 patients were included in the analysis, with 1750 who underwent SDE and 2001 in the SEEG group. There was no statistically significant difference between groups regarding seizure freedom at last follow-up (OR 1.05; 95 % CI 0.61-1.81; I2 = 56 %; p = 0.86). The SEEG group, however, was associated with lower incidence of complications (OR 0.50; 95 %CI 0.28, 0.91; I2 74 %; p < 0.01), fewer major bleeding events (OR 0.23; 95 %CI 0.11, 0.49; I2 0 %; p < 0.01), fewer post-operative neurological deficits (OR 0.39; 95 %CI 0.21, 0.73; I2 23 %; p < 0.05), and shorter operative time (MD -76.28 min; 95 %CI -101.86, -50.70; I2 92 %; p < 0.05).

CONCLUSION

SEEG and SDE are both effective in achieving seizure freedom for drug-resistant epilepsy patients undergoing invasive monitoring. SEEG may offer advantages in terms of safety and healthcare utilization, with fewer complications and shorter operative times. These findings support the growing adoption of SEEG as a preferred method for epilepsy surgery, though further prospective studies are needed to validate these results.