Comparison of the application of two kinds of iEEG monitoring methods (SEEG <i>vs</i>. SDEG) in patients with “difficult to locate” Intractable Epilepsy_Journal of Epilepsy

Authors：

 LI Chengjun ^* , XU Mingxia ^* ,  LIN Yuanxiang , WANG Feng , YAO Peisen , YU Lianghong , KANG Dezhi , LIN Zhangya

Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;

Corresponding author：

LIN Yuanxiang, Email: lyx99070@163.com

Keywords：

Intractable epilepsy; Subdural ectrodes; Stereoelectroencephalography; Epileptogenic zones

DOI：

10.7507/2096-0247.20200049

Video：

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Objective To explore the advantages and disadvantages of using two intracranial EEG (iEEG) monitoring methods—Subdural ectrodes electroencephalography (SDEG)and Stereoelectroencephalography (SEEG), in patients with “difficult to locate” Intractable Epilepsy. Methods Retrospectively analyzed the data of 60 patients with SDEG monitoring (49 cases) and SEEG monitoring (11 cases) from January 2010 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical. Observe and statistically compare the differences in the evaluation results of epileptic zones, surgical efficacy and related complications of the two groups of patients, and review the relevant literature. Results The results showed that the two groups of SDEG and SEEG had no significant difference in the positive rate and surgical resection rate of epileptogenic zones, but the bilateral implantation rate of SEEG (5/11, 45.5%) was higher than that of SDEG (18/49, 36.7%). At present, there was no significant difference in the postoperative outcome among patients with epileptic zones resected after SDEG and SEEG monitoring (P>0.05). However, due to the limitation of the number of SEEG cases, it is not yet possible to conclude that the two effects were the same. There was a statistically significant difference in the total incidence of serious complications of bleeding or infection between the two groups (SDEG 20 cases vs. SEEG 1 case, P<0.05). There was a statistically significant difference in the total incidence of significant headache or cerebral edema between the two groups (SDEG 26 cases vs. SEEG 2 cases, P<0.05). There was a statistically significant difference in the incidence of cerebrospinal fluid leakage, subcutaneous fluid incision, and poor healing of incision after epileptic resection (SDEG 14 cases vs. SEEG 0 case, P<0.05); there were no significant differences in dysfunction of speech, muscle strength between the two groups (P>0.05). Conclusion SEEG has fewer complications than SDEG, SEEG is safer than SDEG. The two kinds of iEEG monitoring methods have advantages in the localization of epileptogenic zones and the differentiation of functional areas. The effective combination of the two methods in the future may be more conducive to the location of epileptic zones and functional areas.

Citation： LI Chengjun, XU Mingxia, LIN Yuanxiang, WANG Feng, YAO Peisen, YU Lianghong, KANG Dezhi, LIN Zhangya. Comparison of the application of two kinds of iEEG monitoring methods (SEEG vs. SDEG) in patients with “difficult to locate” Intractable Epilepsy. Journal of Epilepsy, 2020, 6(4): 307-314. doi: 10.7507/2096-0247.20200049 Copy

1.	Hupalo M, Wojcik R, Jaskolski DJ, et al. Intracranial video-EEG monitoring in presurgical evaluation of patients with refractory epilepsy. Neurol Neurochir Pol, 2017, 51(3): 201-207.
2.	Katz JS, Abel TJ. Stereoelectroencephalography versus subdural electrodes for localization of the epileptogenic zone: what is the evidence? Neurotherapeutics, 2019, 16(1): 59-66.
3.	Gonzalez-Martinez J, Najm IM. Indications and selection criteria for invasive monit-oring in children with cortical dysplasia. Childs Nerv Syst, 2014, 30(11): 1823-1829.
4.	Joswig H, Steven DA, Parrent AG, et al. Intracranial electroencephalographic monitoring: from subdural to depth electrodes. Can J Neurol Sci, 2018, 45(3): 336-338.
5.	Kovac S, Vakharia VN, Scott C, et al. Invasive epilepsy surgery evaluation. Seizure, 2017, 44: 125-136.
6.	Enatsu R, Bulacio J, Najm I, et al. Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy. J Clin Neurosci, 2014, 21(8): 1441-1445.
7.	Podkorytova I, Hoes K, Lega B, et al. Stereoencephalography versus subdural electrodes for seizure localization. Neurosurg Clin N Am, 2016, 27(1): 97-109.
8.	Engel J Jr. Update on surgical treatment of the epilepsies. Summary of the Second International Palm Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology, 1993, 43(8): 1612-1617.
9.	Ramantani G, Maillard L, Koessler L, et al. Correlation of invasive EEG and scalp EEG. Seizure, 2016, 41: 196-200.
10.	Yang M, Ma Y, Li W, et al. A Retrospective analysis of stereoelectroencephalo-graphy and subdural electroencephalography for preoperative evaluation of intractable epilepsy. Stereotact Funct Neurosurg, 2017, 95(1): 13-20.
11.	Minotti L, Montavont A, Scholly J, et al. Indications and limits of stereoelectroence-phalography (SEEG). Neurophysiol Clin, 2018, 48(1): 15-24.
12.	Fujimoto A, Okanishi T, Kanai S, et al. Neuronavigation-guided frameless stereoelectroencephalography (SEEG). Neurol Med Chir (Tokyo), 2017, 57(9): 496-502.
13.	Ollivier I, Behr C, Cebula H, et al. Efficacy and safety in frameless robot-assisted stereo-electroencephalography (SEEG) for drug-resistant epilepsy. Neurochirurgie, 2017, 63(4): 286-290.
14.	Candela-Cantá S, Aparicio J, Lápez JM, et al. Frameless robot-assisted stereo-electroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues. Acta Neurochir (Wien), 2018, 160(12): 2489-2500.
15.	Enatsu R, Mikuni N. Invasive evaluations for epilepsy surgery: a review of the literature. Neurol Med Chir (Tokyo), 2016, 56(5): 221-227.
16.	Fountas KN, Smith JR. Subdural electrode-associated complications: a 20-year experience. Stereotact Funct Neurosurg, 2007, 85(6): 264-272.
17.	Arya R, Mangano FT, Horn PS, et al. Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: a systematic review and meta-analysis. Epilepsia, 2013, 54(5): 828-839.
18.	Nair DR, Burgess R, McIntyre CC, et al. Chronic subdural electrodes in the management of epilepsy. Clin Neurophysiol, 2008, 119(1): 11-28.
19.	Lee WS, Lee JK, Lee SA, et al. Complications and results of subdural grid electrode implantation in epilepsy surgery. Surg Neurol, 2000, 54(5): 346-351.
20.	Mullin JP, Shriver M, Alomar S, et al. Is SEEG safe? A systematic review and meta-analysis of stereoelectroencephalography related complications. Epilepsia, 2016, 57(3): 386-401.
21.	Sacino MF, Huang SS, Schreiber J, et al. Is the use of Stereotactic electroencephalography safe and effective in children? A Meta-analysis of the use of stereotactic electroencephalography in comparison to subdural grids for invasive epilepsy monitoring in pediatric subjects. Neurosurgery, 2018, 22(1): 1-11.
22.	Ho AL, Muftuoglu Y, Pendharkar AV, et al. Robot-guided pediatric stereoelectroencephalography: single-institution experience. J Neurosurg Pediatr, 2018, 22(5): 1-8.

1. Hupalo M, Wojcik R, Jaskolski DJ, et al. Intracranial video-EEG monitoring in presurgical evaluation of patients with refractory epilepsy. Neurol Neurochir Pol, 2017, 51(3): 201-207.
2. Katz JS, Abel TJ. Stereoelectroencephalography versus subdural electrodes for localization of the epileptogenic zone: what is the evidence? Neurotherapeutics, 2019, 16(1): 59-66.
3. Gonzalez-Martinez J, Najm IM. Indications and selection criteria for invasive monit-oring in children with cortical dysplasia. Childs Nerv Syst, 2014, 30(11): 1823-1829.
4. Joswig H, Steven DA, Parrent AG, et al. Intracranial electroencephalographic monitoring: from subdural to depth electrodes. Can J Neurol Sci, 2018, 45(3): 336-338.
5. Kovac S, Vakharia VN, Scott C, et al. Invasive epilepsy surgery evaluation. Seizure, 2017, 44: 125-136.
6. Enatsu R, Bulacio J, Najm I, et al. Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy. J Clin Neurosci, 2014, 21(8): 1441-1445.
7. Podkorytova I, Hoes K, Lega B, et al. Stereoencephalography versus subdural electrodes for seizure localization. Neurosurg Clin N Am, 2016, 27(1): 97-109.
8. Engel J Jr. Update on surgical treatment of the epilepsies. Summary of the Second International Palm Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology, 1993, 43(8): 1612-1617.
9. Ramantani G, Maillard L, Koessler L, et al. Correlation of invasive EEG and scalp EEG. Seizure, 2016, 41: 196-200.
10. Yang M, Ma Y, Li W, et al. A Retrospective analysis of stereoelectroencephalo-graphy and subdural electroencephalography for preoperative evaluation of intractable epilepsy. Stereotact Funct Neurosurg, 2017, 95(1): 13-20.
11. Minotti L, Montavont A, Scholly J, et al. Indications and limits of stereoelectroence-phalography (SEEG). Neurophysiol Clin, 2018, 48(1): 15-24.
12. Fujimoto A, Okanishi T, Kanai S, et al. Neuronavigation-guided frameless stereoelectroencephalography (SEEG). Neurol Med Chir (Tokyo), 2017, 57(9): 496-502.
13. Ollivier I, Behr C, Cebula H, et al. Efficacy and safety in frameless robot-assisted stereo-electroencephalography (SEEG) for drug-resistant epilepsy. Neurochirurgie, 2017, 63(4): 286-290.
14. Candela-Cantá S, Aparicio J, Lápez JM, et al. Frameless robot-assisted stereo-electroencephalography for refractory epilepsy in pediatric patients: accuracy, usefulness, and technical issues. Acta Neurochir (Wien), 2018, 160(12): 2489-2500.
15. Enatsu R, Mikuni N. Invasive evaluations for epilepsy surgery: a review of the literature. Neurol Med Chir (Tokyo), 2016, 56(5): 221-227.
16. Fountas KN, Smith JR. Subdural electrode-associated complications: a 20-year experience. Stereotact Funct Neurosurg, 2007, 85(6): 264-272.
17. Arya R, Mangano FT, Horn PS, et al. Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: a systematic review and meta-analysis. Epilepsia, 2013, 54(5): 828-839.
18. Nair DR, Burgess R, McIntyre CC, et al. Chronic subdural electrodes in the management of epilepsy. Clin Neurophysiol, 2008, 119(1): 11-28.
19. Lee WS, Lee JK, Lee SA, et al. Complications and results of subdural grid electrode implantation in epilepsy surgery. Surg Neurol, 2000, 54(5): 346-351.
20. Mullin JP, Shriver M, Alomar S, et al. Is SEEG safe? A systematic review and meta-analysis of stereoelectroencephalography related complications. Epilepsia, 2016, 57(3): 386-401.
21. Sacino MF, Huang SS, Schreiber J, et al. Is the use of Stereotactic electroencephalography safe and effective in children? A Meta-analysis of the use of stereotactic electroencephalography in comparison to subdural grids for invasive epilepsy monitoring in pediatric subjects. Neurosurgery, 2018, 22(1): 1-11.
22. Ho AL, Muftuoglu Y, Pendharkar AV, et al. Robot-guided pediatric stereoelectroencephalography: single-institution experience. J Neurosurg Pediatr, 2018, 22(5): 1-8.

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Comparison of the application of two kinds of iEEG monitoring methods (SEEG vs. SDEG) in patients with “difficult to locate” Intractable Epilepsy

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