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Epileptic Disorders - Editor's Choice

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November, 2014

Stereo-electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre-surgical diagnosis, independent of age

Epileptic Disorders September 2014

Taussig D, Chipaux M, Lebas A, Fohlen M, Bulteau C, Ternier J, Ferrand-Sorbets S, Delalande O, Dorfm├╝ller G.
Epileptic Disorders. 2014 Sep;16(3):280-95

Commentary by Pr. Philippe Kahane, Epileptic Disorders Associate Editor, Associate Editor
Director Epilepsy Unit, Neurology & Psychiatry Department Grenoble University Hospital, France

More than half a century after its development at Sainte Anne Hospital in Paris (1), the SEEG methodology, both in adults and children, has gained an increasing interest worldwide. For many years, the method has remained challenging in the young paediatric population, both for technical reasons (thickness and rigidity of the skull, tolerance to long-term monitoring) and for age-related semiological and neurophysiological peculiarities, which make localizing hypotheses more complex and difficult to elaborate than in adults.

Only a few studies have dealt specifically with SEEG in children (2, 3), thus making the present publication from the Rothschild Foundation team in Paris particularly interesting. Delphine Taussig and colleagues report their experience on the largest published series of SEEG in children (n=65), putting emphasis on the safety of the procedure (no morbidity, even in children as young as 20 months) and efficiency (78% of the patients eventually received surgery).

Interestingly, a large majority of the surgical procedures were monolobar, even in young children, which contrasts with the common idea that large resections are often mandatory at this age group. Such results confirm and underscore the fact that the main aim of SEEG investigations is to tailor the resections. Overall, 67% of the children became seizure-free (Engel class I), with results that appear better in young patients (n=21; age at SEEG < 5 years; seizure-free: 79%) as compared with the older children (n=44; age at SEEG > 5 years; seizure-free: 59%).

Importantly, surgery was finally offered in more than 3/4 of the most complicated cases (25/32), with results that remained very good (64% of Engel class I). Even patients whose pathology finally proved normal or inconclusive - a finding, which remains challenging in the field of epilepsy surgery - could do well after surgery, although the rate of seizure freedom proved much less satisfactory (36% of Engel class I).

Overall, the merit of this study is to exist, and to serve as a reference in the field of invasive evaluation in children older than 2 years of age. The advent of 3D multimodality imaging methods should help in the future to better target the regions suspected to be epileptogenic, in order to avoid a second SEEG investigation (which represented almost 10% of the cases) and improve surgical results (17% of the children were classified as Engel class IV after surgery).

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References:

  1. Bancaud. Apport de l’exploration fonctionnelle par voie stéréotaxique à la chirurgie de l’épilepsie. Neurochirurgie 1959;5:5–112.
  2. Cossu et al. Stereo-EEG in children. Childs Nerv Syst 2006;22:766-778.
  3. Cossu et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in infancy and early childhood. J Neurosurg Pediatr 2012;9:290-300.

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