Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability

Chan, Alvin Y.; Kharrat, Sohayla; Lundeen, Kelly; Mnatsakanyan, Lilit; Sazgar, Mona; Sen‐Gupta, Indranil; Lin, Jack J.; Hsu, Frank P.K.; Vadera, Sumeet

doi:10.1111/epi.13737

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…First, waiting to record a spontaneous seizure can be time consuming; one study found the average length of stay to be 7 days in their invasive monitoring unit. 24 Recording of interictal activity, on the other hand, only requires a few hours of EEG monitoring. Second, the identification of the seizure onset zone is difficult, and while quantitative methods exist, some only apply to certain seizure types and their ability to predict surgical outcome has not been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

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Interictal spike networks predict surgical outcome in patients with drug‐resistant focal epilepsy

Azeem

Ellenrieder

Hall

et al. 2021

Ann Clin Transl Neurol

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Objective: To determine if properties of epileptic networks could be delineated using interictal spike propagation seen on stereo-electroencephalography (SEEG) and if these properties could predict surgical outcome in patients with drug-resistant epilepsy. Methods: We studied the SEEG of 45 consecutive drug-resistant epilepsy patients who underwent subsequent epilepsy surgery: 18 patients with good postsurgical outcome (Engel I) and 27 with poor outcome (Engel II-IV). Epileptic networks were derived from interictal spike propagation; these networks described the generation and propagation of interictal epileptic activity. We compared the regions in which spikes were frequent and the regions responsible for generating spikes to the area of resection and post-surgical outcome. We developed a measure termed source spike concordance, which integrates information about both spike rate and region of spike generation. Results: Inclusion in the resection of regions with high spike rate is associated with good post-surgical outcome (sensitivity = 0.82, specificity = 0.73). Inclusion in the resection of the regions responsible for generating interictal epileptic activity independently of rate is also associated with good post-surgical outcome (sensitivity = 0.88, specificity = 0.82). Finally, when integrating the spike rate and the generators, we find that the source spike concordance measure has strong predictability (sensitivity = 0.91, specificity = 0.94). Interpretations: Epileptic networks derived from interictal spikes can determine the generators of epileptic activity. Inclusion of the most active generators in the resection is strongly associated with good post-surgical outcome. These epileptic networks may aid clinicians in determining the area of resection during pre-surgical evaluation.

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Section: Discussionmentioning

confidence: 99%

“…There are benefits to using IED‐based networks over seizure networks. First, waiting to record a spontaneous seizure can be time consuming; one study found the average length of stay to be 7 days in their invasive monitoring unit 24 . Recording of interictal activity, on the other hand, only requires a few hours of EEG monitoring.…”

Section: Discussionmentioning

confidence: 99%

Interictal spike networks predict surgical outcome in patients with drug‐resistant focal epilepsy

Azeem

Ellenrieder

Hall

et al. 2021

Ann Clin Transl Neurol

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“…In addition, a longer period of implantation might pose a higher risk of infection rate (although no infections where registered in our SEEG series 7 ). As a general rule, longer admissions may have a direct negative impact in institutional profitability, however, some authors have questioned this in the particular setting of SEEG 8 . Despite this, the need to reschedule other patients for delays in beds' turnover can affect workflows and ultimately have a negative economic impact in the institution.…”

Section: Discussionmentioning

confidence: 99%

Lack of spontaneous typical seizures during intracranial monitoring with stereo‐electroencephalography

Bottan,

Alshahrani,

Gilmore

et al. 2023

Epileptic Disorders

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ObjectiveIn the presurgical evaluation of patients with drug‐resistant epilepsy (DRE), occasionally, patients do not experience spontaneous typical seizures (STS) during a stereo‐electroencephalography (SEEG) study, which limits its effectiveness. We sought to identify risk factors for patients who did not have STS during SEEG and to analyze the clinical outcomes for this particular set of patients.MethodsWe conducted a retrospective analysis of all patients with DRE who underwent depth electrode implantation and SEEG recordings between January 2013 and December 2018.ResultsSEEG was performed in 155 cases during this period. Eleven (7.2%) did not experience any clinical seizures (non‐STS group), while 143 experienced at least one patient‐typical seizure during admission (STS group). No significant differences were found between STS and non‐STS groups in terms of patient demographics, lesional/non‐lesional epilepsy ratio, pre‐SEEG seizure frequency, number of ASMs used, electrographic seizures or postoperative seizure outcome in those who underwent resective surgery. Statistically significant differences were found in the average number of electrodes implanted (7.0 in the non‐STS group vs. 10.2 in STS), days in Epilepsy Monitoring Unit (21.8 vs. 12.8 days) and the number of cases that underwent resective surgery following SEEG (27.3% vs 60.8%), respectively. The three non‐STS patients (30%) who underwent surgery, all had their typical seizures triggered during ECS studies. Three cases were found to have psychogenic non‐epileptic seizures. None of the patients in the non‐STS group were offered neurostimulation devices. Five of the non‐STS patients experienced transient seizure improvement following SEEG.ConclusionWe were unable to identify any factors that predicted lack of seizures during SEEG recordings. Resective surgery was only offered in cases where ECS studies replicated patient‐typical seizures. Larger data sets are required to be able to identify factors that predict which patients will fail to develop seizures during SEEG.

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Expanding eligibility for intracranial electroencephalography using Dexmedetomidine Hydrochloride in children with behavioral dyscontrol

Johnstone,

Isabel Barros Guinle,

Grant

et al. 2024

Epilepsy & Behavior

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Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability

Cited by 5 publications

References 12 publications

Interictal spike networks predict surgical outcome in patients with drug‐resistant focal epilepsy

Interictal spike networks predict surgical outcome in patients with drug‐resistant focal epilepsy

Lack of spontaneous typical seizures during intracranial monitoring with stereo‐electroencephalography

Expanding eligibility for intracranial electroencephalography using Dexmedetomidine Hydrochloride in children with behavioral dyscontrol

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