Is the use of Stereotactic Electroencephalography Safe and Effective in Children? A Meta-Analysis of the use of Stereotactic Electroencephalography in Comparison to Subdural Grids for Invasive Epilepsy Monitoring in Pediatric Subjects

Abstract

BACKGROUND Stereoelectroencephalography (SEEG) is an alternative addition to subdural grids (SDG) in invasive extra-operative monitoring for medically refractory epilepsy. Few studies exist on the clinical efficacy and safety of these techniques in pediatric populations. OBJECTIVE To provide a comparative quantitative summary of surgical complications and postoperative seizure freedom associated with invasive extra-operative presurgical techniques in pediatric patients. METHODS The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was conducted utilizing Ovid Medline, Embase, Pubmed, and the Cochrane database. RESULTS Fourteen papers with a total of 697 pediatric patients undergoing invasive SDG monitoring and 9 papers with a total of 277 pediatric patients undergoing SEEG monitoring were utilized in the systemic review. Cerebral spinal fluid (CSF) leaks were the most common adverse event in the SDG studies (pooled prevalence 11.9% 95% confidence interval [CI] 5.7-23.3). There was one case of CSF leak in the SEEG studies. Intracranial hemorrhages (SDG: 10.7%, 95% CI 5.3-20.3; SEEG: 2.9%, 95% CI –0.7 to 10.8) and infection (SDG: 10.8%, 95% CI 6.7-17) were more common in the SDG studies reviewed. At the time of the last postoperative visit, a greater percentage of pediatric patients achieved seizure freedom in the SEEG studies (SEEG: 66.5%, 95% CI 58.8-73.4; SDG: 52.1%, 95% CI 43.0-61.1). CONCLUSION SEEG is a safe alternative to SDG and should be considered on an individual basis for selected pediatric patients.

<p>Stereoelectroencephalography in epilepsy, cognitive neurophysiology, and psychiatric disease: safety, efficacy, and place in therapy</p>

“…While the above findings stem from mixed-age studies, one meta-analysis of specifically pediatric patients found similarly favorable results 20. After SEEG, 2.9% of the pediatric patients suffered from ICH and no patients were reported to have infectious complications.…”

Technical Aspects of SEEG and Its Interpretation in the Delineation of the Epileptogenic Zone

“…7,8) Its quick gain of popularity in a number of North American centers over a few years has contributed to the mounting recent evidence suggesting that SEEG is safer than SDE study. In contrast to the reported complication rates of SDE (5%-17%), [9][10][11][12][13] a meta-analysis on 4000 patients has shown that the rate is much lower (<1%) for SEEG. 14) A recent analysis of 239 patients that directly compared the two approaches has shown that implantation of SEEG electrodes is less time-consuming and less morbid, resulting in less postoperative pain and better seizure outcome in non-lesional cases.…”

“…In general, most centers prefer to use SDE in younger and SEEG in older children, with a cutoff around 3-to 4-year old. 12,19,20)…”

Stereoelectroencephalography in Pediatric Epilepsy Surgery

“…Yang et al [96] performed an institutional study comparing outcomes from SDG (n=52) and SEEG (n=48), observing higher rates of ICH and surgical site infection among SDG patients. In a meta-analysis comparing SDG and SEEG, Sacino et al [84] reviewed 23 papers featuring 974 children (SDG, 697; SEEG, 277), finding that SDG cases had a higher pooled-prevalence of CSF leak, infection, and ICH, as well as a lower overall seizure-freedom rate (SDG, 52.1% vs. SEEG, 66.5%).…”