Stereo-eeg Monitoring: When No Clinical Seizures Are Recorded
Abstract number :
2.461
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
1041
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Carolina Gil Tommee, MD – Mayo Clinic, Rochester, MN
Benjamin Brinkmann, PhD – Department of Neurology, Mayo Clinic, Rochester MN USA
Jeffrey Britton, MD – Department of Neurology, Mayo Clinic, Rochester MN USA
Jamie Van Gompel, MD – Mayo Clinic
Kai Miller, MD, PhD – Mayo Clinic
Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine
David Burkholder, MD – Mayo Clinic
Kelsey Smith, MD – Department of Neurology, Mayo Clinic, Rochester MN USA
Rationale: Stereo-EEG (sEEG) is an invasive and resource intensive procedure associated with potential complications. The objective of this study was to identify patients who did not have clinical seizures recorded when undergoing sEEG monitoring, to describe their outcomes, and to look at factors associated with lack of clinical seizures.
Methods: We conducted a retrospective analysis from a database of patients who underwent sEEG for drug-resistant epilepsy at Mayo Clinic in Rochester, MN. We identified patients who did not have clinical seizures recorded while implanted. Charts were reviewed to describe clinical factors and outcomes after sEEG monitoring and to determine factors associated with the lack of clinical seizures.
Results: Of 239 implanted with sEEG from January 2015-December 2022, five patients (2%) did not have clinical seizures recorded. The median age at implantation for this group was 8 (range 4-28), and three were pediatric patients. Four of the five patients had lesional MRIs, including three with possible focal cortical dysplasias (FCD), and one patient had encephalomalacia in the right middle cerebral artery territory from a perinatal infarct. The median length of sEEG recording was 16 days (range 13-28) with a median of 13 recording electrodes (range 13-15), with all five patients having a unilateral implant. Only one patient had subclinical seizures recorded. Two patients underwent further intervention; one patient had radiofrequency ablation (RFA) based on frequent interictal discharges and had recurrence of seizures after 5 months. The second patient had RFA targeting areas of subclinical seizure onset and subsequently underwent resection of an FCD and was seizure free for 18 months at last follow-up. The length of follow-up after sEEG for the three without an intervention was 3, 25 and 31 months. One patient had seizure recurrence one month after explant. Compared to the 235 patients who had clinical seizures recorded, those with no clinical seizures were monitored for longer (mean 6.056 days vs 19.00 days, p-value 0.002) and more likely to have a unilateral implant (100% vs. 51%, p-value 0.030).
Conclusions: Identifying factors that can predict absence of clinical seizures during sEEG is important. In our study, it was rare for patients to not have clinical seizures recorded. Those without clinical seizures were more likely to have a unilateral implant. Despite the lack of clinical seizures during sEEG, two patients underwent further intervention, highlighting the diagnostic and therapeutic utility of sEEG in guiding treatment strategies.
Funding: No funding was required for this study.
Surgery