Castro-Villablanca, Felipe;
Moeller, Friederike;
Pujar, Suresh;
D'Arco, Felice;
Scott, Rod C;
Tahir, M Zubair;
Tisdall, Martin;
... Eltze, Christin; + view all
(2022)
Seizure outcome determinants in children after surgery for single unilateral lesions on MRI: role of preoperative ictal and interictal EEG.
Epilepsia
, 63
(12)
pp. 3168-3179.
10.1111/epi.17425.
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Abstract
OBJECTIVE: To determine if an ictal EEG recording as part of pre-surgical evaluation of children with a demarcated single unilateral MRI lesion is indispensable for surgical decision making, we investigated the relationship between interictal/ ictal EEG and seizure semiology with seizure-free outcome. METHODS: Data were obtained retrospectively from consecutive patients (≤ 18 years) undergoing epilepsy surgery with a single unilateral MRI lesion at our institution over a 6-year period. Video-telemetry EEG (VT-EEG) was classified as concordant or non-concordant/non-informative in relation to the MRI lesion location. The odds of seizure-free outcome associated with non-concordant versus concordant for 'semiology', 'interictal' and 'ictal' EEG were compared separately. Multivariable logistic regression was conducted to correct for confounding variables. RESULTS: After a median follow-up of 26 months (IQR 17-37.5) 73 (69%) of 117 children enrolled were seizure free. Histopathological diagnoses included: low-grade epilepsy associated tumours 46 (39%), Focal Cortical Dysplasia (FCD) 33 (28%), mesial temporal sclerosis (MTS) 23 (20%), polymicrogyria 3, 3%) and non-diagnostic findings/gliosis 12 (10%). The odds of seizure freedom was lower with a non-concordant interictal EEG (OR=0.227, 95% CI 0.079 to 0.646, p=0.006) and non-concordant ictal EEG (OR=0.359, 95%CI 0.15 - 0.878, p=0.035). In the multivariable logistic regression model, factors predicting lower odds for seizure free outcome were developmental delay/intellectual disability, higher number of anti-seizure medications tried and a non-significant trend for 'non-concordant interictal EEG'. In the combined subgroup of patients with FCD and tumours (n=79) there was no significant relationship of VT-EEG factors and seizure outcomes, whilst in children with MTS and acquired lesions (n=25) a non- concordant EEG was associated with poorer seizure outcomes) p =0.003). SIGNIFICANCE: An ictal EEG may not be mandatory for pre-surgical evaluation, particularly when a well-defined single unilateral MRI lesion has been identified and the interictal EEG is concordant.
| Type: | Article |
|---|---|
| Title: | Seizure outcome determinants in children after surgery for single unilateral lesions on MRI: role of preoperative ictal and interictal EEG |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/epi.17425 |
| Publisher version: | https://doi.org/10.1111/epi.17425 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | EEG, epilepsy surgery, presurgical evaluation, video-EEG use in pediatrics |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10156811 |
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