Authors :
Presenting Author: Rene Andrade Machado, MD – Children Hospital of Wisocnsin
Norton Natalie, Medical Student – Medical College of Wisconsin
Shruti L Narayan, Medical Student – Medical College of Wisconsin
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Sean Lew, MD – Medical College of Wisconsin
Irene Kim, MD – Medical College of Wisconsin
Rationale:
|
Recently, six seizure-onset patterns of patients with FCD and neurodevelopmental tumors were identified during SEEG studies. However, only a minority of the above-mentioned studies found a correlation between SEEG patterns and other underlying pathologies in children with temporal lobe epilepsy. These studies evaluated the ictal onset patterns but not the role of early spread patterns according to different pathologies. They do not evaluate the role of a "healthy hippocampus" in this ictal pattern or the different ictal patterns according to different topographic regions in the temporal lobe of the developing brain. Overall, this study aims to determine the intracranial ictal onset patterns and early spread patterns in pediatric patients with Temporal lobe epilepsy and its possible association with histopathology, temporal structure involved, mesial structural pathology, and possible implication in postsurgical outcome.
|
|
Methods: A descriptive, retrospective, cross-sectional, study was carried out in a group of children from Children’s Wisconsin in the period between 2016 and 2022.Nineteen out of twenty-five patients were included in this study. Six patients were excluded from the study for the following reasons: (one patient's SEEG file was not available, one ended up with a hemispherectomy, two patients had multifocal epilepsy, one had a left parietal hematoma leading to SEEG discontinuation, and in one, the ictal onset zone was not localized) thus; we included nineteen patients, with a total of 94 seizures in the present study. The ictal onset and early spread of intracranial EEG were classified based on the frequency, amplitude, morphology, and presence of slow potential shift (SPS) (we do not use any previously reported intracranial ictal patterns).
Statistical analysis: Data are presented as numbers and percentages in tables and figures.
Results: This study showed a strong association between ictal onset patterns and underlying histology (p< 0.05). LFHA periodic spikes were seen only in patients with HS (20.6 %). A strong statistically significant association was found between different ictal onset patterns and the temporal lobe structure involved in the ictal onset (p< 0.001). Seizures with ictal onset consisting of SPS with superimposed LVFA arise from the Inferior Temporal Lobe (ITL) or Middle Temporal Gyrus (MTG) in a more significant proportion of seizures than those that originated from mesial temporal structures (Difference of proportion; p< 0.05). LFHA periodic spikes as ictal pattern was seen in a patient with seizures arising outside the mesial temporal structure. The most frequent early spread patterns observed was LVFA (89.4%), this pattern did not depend on the type of mesial structure pathology. Ictal onset patterns were associated with postsurgical outcomes (p< 0.001). Ictal onset
pattern seems to depend on the histopathology in the ictal onset zone and the temporal lobe structure involved in the ictal onset (p= 0.001)Conclusions: Intracranial ictal onset patterns in TLE depend on underlying histology and the temporal lobe structure involved in its onset.
Funding: None