Authors :
Presenting Author: Geetha Vasudevan, MD – UPMC Children's Hospital of Pittsburgh
Leen Alkalbani, MD – Children's Hospital of Pittsburgh, UPMC
Emily Harford, MA – Children's Hospital of Pittsburgh, UPMC
Melissa Sutcliffe, PhD – Children's Hospital of Pittsburgh, UPMC
Sarah Laughlin, PhD – Children's Hospital of Pittsburgh, UPMC
Himadri Patel, MD – Children's Hospital of Pittsburgh, UPMC
Nicholas Benjamin, MD – Children's Hospital of Pittsburgh, UPMC
Mikaela Speakes, MD – Children's Hospital of Pittsburgh, UPMC
Taylor Abel, MD – Children's Hospital of Pittsburgh, UPMC
William Welch, MD – Children's Hospital of Pittsburgh, UPMC
Ruba Al-Ramadhani, MD – Children's Hospital of Pittsburgh, UPMC
Rationale:
Literature shows that surgical planning for patients with non-lesional focal epilepsy is more challenging than those with MRI positive epilepsies. Despite these findings, direct comparative studies focusing exclusively on pediatric populations and systematically evaluating differences in neurosurgical interventions and seizure outcomes after stereo-electroencephalography (sEEG) between MRI-positive and MRI-negative groups remain limited. This study aims to understand the differences in neurosurgical intervention and seizure freedom outcomes after sEEG for pediatric patients with drug resistant epilepsy (DRE) with and without MRI identified lesions.
Methods:
This is a retrospective analysis from a centralized sEEG patient database maintained by UPMC Children’s Hospital. Sixty-six patients underwent 68 sEEGs for DRE. Patients were divided into MRI positive (60.3%) and MRI negative groups. Characteristics pertaining to number of trajectories per patient, rates of neurosurgical intervention, rates of seizure freedom were compared among populations.
Results:
At baseline, MRI-positive and MRI-negative patients significantly differed in age of seizure onset, where MRI-positive patients experienced seizure onset at a younger age (median = 3 years old (yo)) compared to MRI-negative patients (median = 10 yo, p=0.008). Invasive monitoring in the MRI-negative group involved significantly more trajectories per patient (median = 16, p=0.004). The overall proportion of patients undergoing post-sEEG neurosurgical intervention did not differ between groups. The MRI-positive group underwent surgical resection at a higher proportion (71.4%) when compared to MRI-negative patients. Rates of seizure freedom (Engel Class I), did not differ between groups with 57.5% of MRI -positive patients and 52% of MRI-negative patients attaining seizure freedom. The median number of anti-seizure medications (ASMs) per patient at follow up did not differ significantly between groups as well (median = 2) – Table 1.
Conclusions:
Our findings conclude that while MRI-positive patients with DRE exhibit earlier seizure onset and are more likely to undergo resective surgery following sEEG, the presence of positive MRI findings does not independently predict seizure freedom at follow-up post-neurosurgical intervention. However, this contrasts with existing literature, which suggests that the presence of a lesion on MRI is associated with higher rates of seizure freedom in children undergoing SEEG-guided surgery (1). These discrepancies highlight the value of sEEG as a tool to precisely identify the seizure onset zone, and the need for larger studies to investigate the outcome differences in this population.
References: (1) Kim W, Shen MY, Provenzano FA, Lowenstein DB, McBrian DK, Mandel AM, Sands TT, Riviello JJ, McKhann GM, Feldstein NA, Akman CI. The role of stereo-electroencephalography to localize the epileptogenic zone in children with nonlesional brain magnetic resonance imaging. Epilepsy Res. 2022 Jan;179:106828.
Funding: N/A