The Utility of Noninvasive Current Electrical Localization Technique in Epilepsy Surgery in Patients with Tuberous Sclerosis Complex
Abstract number :
1.185
Submission category :
3. Neurophysiology / 3G. Computational Analysis & Modeling of EEG
Year :
2021
Submission ID :
1826655
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Susanne Yoon, MD - Children's National Hospital; Nancy Elling - Children's National Hospital; William Gaillard - Children's National Hospital; Amy Kao - FDA; William McClintock - Children's National Hospital; Chima Oluigbo - Children's National Hospital; Archana Pasupuleti - Children's National Hospital; Manu Krishnamurthy - Children's National Hospital; Emily Matuska - Children's National Hospital
Rationale: The challenges of epilepsy surgery in children with Tuberous Sclerosis Complex include multifocal nature of the epileptogenic focus as well as the ambiguous surgical margin of epileptogenic tuber that is beyond the positive MRI findings. There have been multiple studies using noninvasive electrical or magnetic source localization. However, the challenge is the magnetic source localization is not readily available in all centers. Here we report 4 cases of patients with TSC and refractory localization related epilepsy who underwent the resective surgery using CURRY to further confirm the epileptogenic zone to guide the surgical target.
Methods: In addition to standard presurgical evaluation, 4 patients with refractory localization epilepsy from 2018-2020 had CURRY. We compared the concordance of CURRY data with the epileptogenic focus collected in other presurgical evaluation. Then we compared the resection cavity with CURRY density model to compare the concordance of epileptogenic zone and resection are and its predilection of outcome.
Results: Of 4 patients, all had multiple tubers in bilateral hemisphere on MRI and bilateral multifocal interictal findings on scalp EEG. In 3 out of 4 patients, CURRY had concordance of data with the scalp EEG findings to lateralize and further localize the epileptogenic zone to tailor the surgical resection. 1 patient remains seizure free. 2 patients achieve Engel IIa and IIIa in outcome respectively. In 1 out of 4 patients, CURRY current density model predicted bilateral, left frontal more than right frontal tubers as the epileptogenic zone. These findings helped tailoring the target of intracranial stereo electroencephalogram to localize the single tuber that was the most epileptogenic. Although this patient had recurred seizures after 22 months after surgery, achieving Engel IIIB outcome, CURRY predicted the next surgical target, sparing the invasive intracranial monitoring. Of the 4 patients, the closer the surgical margin was to the current density model in CURRY, the better outcome was achieved.
Conclusions: CURRY helps to lateralize and further localize the epileptogenic zone in patients with multifocal epileptogenic tubers. The resection of epileptogenic tuber beyond MRI finding as predicted in CURRY current density model predicts a better seizure outcome.
Funding: Please list any funding that was received in support of this abstract.: None.
Neurophysiology