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The Value of Diagnostic Bilateral Intracranial Electroencephalography in Treatment-Resistant Focal Epilepsy. World Neurosurg 2017 Jul;103:1-10

Date

02/12/2017

Pubmed ID

28185968

DOI

10.1016/j.wneu.2017.01.093

Scopus ID

2-s2.0-85018412517   3 Citations

Abstract

OBJECTIVES: We assessed the efficacy and risks of diagnostic bilateral intracranial electroencephalography (bICEEG) in patients with treatment-resistant epilepsy (TRE) with poorly lateralized epileptogenic zone on noninvasive studies as reflected by progress to resection, Engel outcome, and complication rate.

METHODS: This is a retrospective chart review of 199 patients with TRE who had diagnostic bICEEG at New York University Medical Center between 1994 and 2013. Study end points were progress to resection, surgical outcome, and perioperative complications. Univariate analysis was performed with analysis of variance, t test, or Fisher exact test; multivariable analysis was performed using discriminant function analysis.

RESULTS: bICEEG lateralized the epileptogenic zone and the patient had resection in 60.3% of cases. The number of depth electrodes used was positively correlated with resection, and surgical complications during bICEEG negatively correlated. Vagal nerve stimulators were implanted in 58.2% of patients who did not undergo resection and 20.7% of those who did. Among the 87 patients who progressed to resection and had more than 1-year follow-up, 47.1% were seizure free compared with 12.7% of the 55 who did not. Male sex correlated with good postoperative seizure control. The most common complication was infection requiring debridement, occurring in 3.1% of admissions (9 of 290).

CONCLUSIONS: At our center, 60% of patients undergoing bICEEG progress to resection and 57% of these had more than 90% reduction in seizures. We conclude that bICEEG allows the benefits of epilepsy surgery to be extended to patients with poorly lateralized and localized TRE.

Author List

Hill TC, Rubin BA, Tyagi V, Theobald J, Silverberg A, Miceli M, Dugan P, Carlson C, Doyle WK

Author

Chad Carlson MD Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Child
Child, Preschool
Debridement
Discriminant Analysis
Drug Resistant Epilepsy
Electrocorticography
Epilepsies, Partial
Female
Humans
Intraoperative Complications
Male
Middle Aged
Multivariate Analysis
Neurosurgical Procedures
Postoperative Complications
Retrospective Studies
Sex Factors
Surgical Wound Infection
Treatment Outcome
Vagus Nerve Stimulation
Young Adult