Seizure Induced by Cortical Stimulation: Is There a Clinical Value in the Pediatric Population?
Abstract number :
2.052
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2019
Submission ID :
2421501
Source :
www.aesnet.org
Presentation date :
12/8/2019 4:04:48 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Luca De Palma, Ospedale Pediatrico Bambino Gesù; Giusy Carfi Pavia, Bambino Gesù Children Hospital; Alessandri De Benedictis, Bambin Gesù Children Hospital; Simona Cappelletti, Bambino Gesù Children Hospital; Carlo E. Marras, Bambino Gesù Children Hospita
Rationale: Seizure induced by direct electrical cortical stimulations are a useful tool to delineate the seizure onset zone. Until now, a direct comparison of clinical stimulus induced manifestations with habitual seizures was not performed comparing adult and pediatric population. Methods: We review all SEEG performed from 2011 to 2017 and then operated on with a minimum post-surgical follow-up of 12 months. We analyzed the different seizure pattern, spontaneous or induced, considering semiology, electrical activity, age at SEEG, pathology and surgical outcome. We considered two group: patients up to 6 years and with more than 6 years. Results: Thirty-five patients underwent SEEG recordings, with a mean age 14 y +/- 10. The most common etiology was FCD I (13 pts, 37%), followed by FCD II (10 pts, 28%) and non-dysplastic tissue (5 pts, 14%), 7 pts (18%) had other multiple etiologies. Seven pts (20%) had seizure induced by 1 Hz stimulation and 17 (48%) by 50 Hz (24 overall). Seizure induced by cortical stimulation were similar to spontaneous one both with low and high frequency stimulations if we look only at the first clinical signs (100% and 89% respectively) while the concordance decreases to 58% if we look at the clinical evolution. Epileptic spasms (5/35 – 14%) were never reproduced by cortical stimulation. Nine pts were below 6 years, and in 7/9 (77%) we were able to reproduce a typical seizure with no statistical difference with the older group. Regarding the etiology: 7/10 (70%) FCD type II pts had seizures induced by cortical stimulations while only 8/15 (53%) with FCD I. Final outcome was better in the group with provoked seizures (71% vs 60% seizure free) and was similar in the group under 6 year. Conclusions: Electrical-induced seizures are a useful tool to delineate the seizure onset zone and the removal of the provoked ictal onset area allows a better post-surgical outcome. The only exception are epileptic spasms wich were never reproduced. Finally in patients below 6 years the stimulations have the same clinical and prognostic value. Funding: No funding
Neurophysiology