Intracranial electroencephalography with subdural and/or depth electrodes in children with epilepsy: Techniques, complications, and outcomes
Highlights • Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma. • Among 133 patients who underwent resection 48.9% had a seizure-free outcome. • Number of electrode contacts was an independent risk factor for intracranial hematoma.
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| Published in | Epilepsy research Vol. 108; no. 9; pp. 1662 - 1670 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier B.V
01.11.2014
Elsevier |
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| Abstract | Highlights • Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma. • Among 133 patients who underwent resection 48.9% had a seizure-free outcome. • Number of electrode contacts was an independent risk factor for intracranial hematoma. |
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| AbstractList | Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in patients with intractable partial epilepsy; however, data on safety and surgical outcome with this technique are still inadequate. The aims of this study were to assess the morbidity of intracranial recordings and the surgical outcomes in epileptic children. We retrospectively reviewed the clinical data for 137 children with epilepsy (mean age at implantation: 12.6 ± 3.8 years) who underwent intracranial monitoring with the implantation of strip or grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2011 at a tertiary epilepsy center in China. Complications were classified using five grades of severity (including mortality) and were further classified as either minor or severe. Outcome was classified according to Engel's classification. Regression analysis was performed to identify risk factors for complications. The mean duration of implantation was 5.3 ± 1.3 days. Among the 133 patients who underwent resection, 65 (48.9%) were seizure free (Engel Class I) at last known follow-up, which was >2 years after surgery for all patients. Also, 31 (23.3%) patients had a significant reduction in seizures (Engel Class II). Complications of any type were documented in 29 (21.7%) patients; 15 of these patients had intracranial hematoma. The results of multivariate analysis showed that the only independent risk factor for intracranial hematoma was number of electrode contacts. The most common pathologic diagnosis was focal cortical dysplasia (n=58). Our results showed that intracranial electroencephalographic monitoring in children provides good surgical outcomes and the level of risk is acceptable. When using this technique strategies such as using as few electrode contacts as possible should be adopted to minimize the risk of intracranial hematoma. •Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma.•Among 133 patients who underwent resection 48.9% had a seizure-free outcome.•Number of electrode contacts was an independent risk factor for intracranial hematoma. Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in patients with intractable partial epilepsy; however, data on safety and surgical outcome with this technique are still inadequate. The aims of this study were to assess the morbidity of intracranial recordings and the surgical outcomes in epileptic children. We retrospectively reviewed the clinical data for 137 children with epilepsy (mean age at implantation: 12.6±3.8 years) who underwent intracranial monitoring with the implantation of strip or grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2011 at a tertiary epilepsy center in China. Complications were classified using five grades of severity (including mortality) and were further classified as either minor or severe. Outcome was classified according to Engel's classification. Regression analysis was performed to identify risk factors for complications. The mean duration of implantation was 5.3±1.3 days. Among the 133 patients who underwent resection, 65 (48.9%) were seizure free (Engel Class I) at last known follow-up, which was >2 years after surgery for all patients. Also, 31 (23.3%) patients had a significant reduction in seizures (Engel Class II). Complications of any type were documented in 29 (21.7%) patients; 15 of these patients had intracranial hematoma. The results of multivariate analysis showed that the only independent risk factor for intracranial hematoma was number of electrode contacts. The most common pathologic diagnosis was focal cortical dysplasia (n=58). Our results showed that intracranial electroencephalographic monitoring in children provides good surgical outcomes and the level of risk is acceptable. When using this technique strategies such as using as few electrode contacts as possible should be adopted to minimize the risk of intracranial hematoma. Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in patients with intractable partial epilepsy; however, data on safety and surgical outcome with this technique are still inadequate. The aims of this study were to assess the morbidity of intracranial recordings and the surgical outcomes in epileptic children. We retrospectively reviewed the clinical data for 137 children with epilepsy (mean age at implantation: 12.6 ± 3.8 years) who underwent intracranial monitoring with the implantation of strip or grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2011 at a tertiary epilepsy center in China. Complications were classified using five grades of severity (including mortality) and were further classified as either minor or severe. Outcome was classified according to Engel's classification. Regression analysis was performed to identify risk factors for complications. The mean duration of implantation was 5.3 ± 1.3 days. Among the 133 patients who underwent resection, 65 (48.9%) were seizure free (Engel Class I) at last known follow-up, which was >2 years after surgery for all patients. Also, 31 (23.3%) patients had a significant reduction in seizures (Engel Class II). Complications of any type were documented in 29 (21.7%) patients; 15 of these patients had intracranial hematoma. The results of multivariate analysis showed that the only independent risk factor for intracranial hematoma was number of electrode contacts. The most common pathologic diagnosis was focal cortical dysplasia (n=58). Our results showed that intracranial electroencephalographic monitoring in children provides good surgical outcomes and the level of risk is acceptable. When using this technique strategies such as using as few electrode contacts as possible should be adopted to minimize the risk of intracranial hematoma. Highlights • Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma. • Among 133 patients who underwent resection 48.9% had a seizure-free outcome. • Number of electrode contacts was an independent risk factor for intracranial hematoma. |
| Author | Pei, Jia-Sheng Tian, Jun Zhong, Zhong-Hui Mei, Zhen Jia, Yan-Zeng Lin, Qiao Chen, Zi-Qian Yang, Peng-Fan Zhang, Hui-Jian Zheng, Zhi-Yong |
| Author_xml | – sequence: 1 fullname: Yang, Peng-Fan – sequence: 2 fullname: Zhang, Hui-Jian – sequence: 3 fullname: Pei, Jia-Sheng – sequence: 4 fullname: Tian, Jun – sequence: 5 fullname: Lin, Qiao – sequence: 6 fullname: Mei, Zhen – sequence: 7 fullname: Zhong, Zhong-Hui – sequence: 8 fullname: Jia, Yan-Zeng – sequence: 9 fullname: Chen, Zi-Qian – sequence: 10 fullname: Zheng, Zhi-Yong |
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| Keywords | subdural grid electrode computed tomography electroencephalography DE Seizure outcome magnetic resonance imaging grid electrode OR Complications MRI EEG odds ratio Epilepsy surgery CT SE SDE Invasive electroencephalography CSF cerebrospinal fluid strip electrode Depth electrode GE Subdural electrode Human Intracranial Subdural Nervous system diseases Prognosis Epilepsy Electroencephalography Depth Cerebral disorder Electrodes Convulsion Surgery Central nervous system disease Complication Technique Neurological disorder Child |
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| Snippet | Highlights • Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma. • Among 133 patients who underwent resection 48.9% had a... •Complications occurred in 29 (21.7%) patients including 15 who had intracranial hematoma.•Among 133 patients who underwent resection 48.9% had a seizure-free... Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in... |
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| SubjectTerms | Adolescent Biological and medical sciences Brain - physiopathology Child Complications Depth electrode Electrodes, Implanted - adverse effects Electroencephalography Epilepsy - diagnosis Epilepsy - pathology Epilepsy - surgery Female Follow-Up Studies Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Invasive electroencephalography Magnetic Resonance Imaging Male Medical sciences Nervous system (semeiology, syndromes) Neurology Neurosurgical Procedures - methods Retrospective Studies Seizure outcome Subdural electrode Subdural Space - physiopathology Time Factors Treatment Outcome |
| Title | Intracranial electroencephalography with subdural and/or depth electrodes in children with epilepsy: Techniques, complications, and outcomes |
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