Epilepsy control following intracranial monitoring without resection in young children

Abstract

Summary Purpose: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment‐resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery. Methods: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients’ charts, operative reports, and radiologic scans, under an institutional review board–approved protocol. Key Findings: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure‐free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1–2 per week (two patients). The mean age (± standard deviation, SD) at seizure onset was 1.6 ± 1.3 years (range 0.5–4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (± SD) was 4.1 ± 2 years (range 1–7 years), and duration of epilepsy 2.5 ± 1.1 years (range 0.5–4 years). Duration of IM was 11.7 ± 5.6 days (5–19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow‐up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow‐up was 30.6 ± 9.5 months (range 19–41 months). Significance: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network.

Epilepsy surgery in patients with autism

“…Our results support the feasibility of epilepsy surgery in children with ASD, highlight the potential for improved seizure control and associated cognitive-behavioral gains, and attest to the safety of surgical intervention in this population. 21,37,38 Contrary to the prevalent concern that epilepsy surgery in patients with ASD may have limited utility, 10,11,14,40,45 we found that even for severely affected individuals, surgery often had tangible benefits, reducing the burden of seizures and aberrant behaviors on the families and facilities that provide lifelong care to these patients, many of whom require special medical attention and very substantial support due to the presence of developmental delay and other comorbidities.…”

Chronic ambulatory electrocorticography from human speech cortex

“…1B) and ECoG was recorded by the device. Remarkably, the subject subsequently became seizure-free (now over two years), as can rarely occur after intracranial monitoring (Katariwala et al, 2001; Roth et al, 2012). While the neurostimulator continued to record and store ECoG, the responsive stimulation function of the device was never enabled.…”

The implantation effect: delay in seizure occurrence with implantation of intracranial electrodes

“…[2][3][4] There was a similar decrease in seizure frequency whether stimulation is on or off and is referred to as the "implantation effect. 7,8 The absence or decrease in frequency of seizures during iEEG monitoring can result in inability to localize seizure origin, and also results in prolonged hospital stays with increased morbidity and healthcare expense. Every major epilepsy center has patients to report with history of frequent seizures that did not have any after iEEG placement despite withdrawal of medications.…”

“…Very rare patients with drug-resistant epilepsy that underwent iEEG monitoring became seizure-free without resection of the epileptogenic focus. 7,8 The absence or decrease in frequency of seizures during iEEG monitoring can result in inability to localize seizure origin, and also results in prolonged hospital stays with increased morbidity and healthcare expense.…”