Outcomes of stereoelectroencephalography-guided surgery of drug-resistant epileptic spasms and the prognostic factors
Objective To investigate the outcomes of stereoelectroencephalography(SEEG)-guided surgery in patients with drug-refractory epileptic spasm(ES)and the prognostic factors.Methods Patients with drug-refractory ES admitted to the Neurosurgery Department of Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital)from December 2013 to April 2023 were retrospectively analyzed and those required second-stage evaluation for SEEG electrode placement after noninvasive preoperative evaluation were enrolled.Based on SEEG results and imaging characteristic,individualized surgical treatment plans were determined,including radiofrequency thermocoagulation,epileptogenic zonectomy,and laser ablation.Patients were divided into a seizure-free group(Engel Ⅰ grade)and a non-seizure-free group(Engel Ⅱ-Ⅳ grade)based on the presence or absence of seizures after surgery.SEEG characteristics and outcomes of patients were summarized and the influencing factors of surgical outcome were explored.Results A total of 29 patients were enrolled into this study.SEEG results were classified into three types based on the SEEG characteristics during ES:SEEG type Ⅰ in 6 cases,SEEG type Ⅱ in 13 cases,and SEEG type Ⅲ in 10 cases.Among 29 patients,11 patients underwent radiofrequency thermocoagulation,14 patients underwent epileptogenic zonectomy,and 4 patients underwent laser ablation.All patients were followed up with a median of 37 months(range:14-103 months).Nineteen patients(65.5％)were seizure free after focal resection or thermal coagulation,including 6 patients of SEEG type Ⅰ,11 patients of SEEG type Ⅱ,and 2 patients of SEEG type Ⅲ.The difference in SEEG seizure types between the seizure-free group and the non-seizure-free group was statistically significant(P=0.003).The proportion of seizure-free patients in SEEG types Ⅰ(6/6)and Ⅱ(11/13)was higher than that in type Ⅲ patients(2/10)(both P＜0.05),while the difference between type Ⅰ and type Ⅱ patients was not statistically significant(P＞0.05).The age of onset and surgical age of patients in the seizure-free group were both lower than those in the seizure group(both P＜0.05).The proportions of patients with focal positive findings on head MRI and unilateral SEEG electrode placement were both higher in the seizure-free group than in the non-seizure-free group(both P＜0.05).There was no statistically significant difference between the two groups in terms of the disease course,interical EEG or ictal EEG type,the characteristics of spastic seizures,or whether or not there was positive finding in positron emission tomography-computed tomography(all P＞0.05).Conclusions Patients with drug-refractory ES who undergo SEEG-guided surgery can achieve a high postoperative seizure free rate.Children with young onset age,young surgical age,suspicious focal lesion or tuberous sclerosis detected by cranial MRI,and SEEG indicating the origin of focal attacks or focal"leading spikes"have better surgical outcomes.
Drug resistant epilepsyNeurosurgical proceduresPrognosisEpileptic spasmStereoelectroencephalographyRoot cause analysis
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