ObjectiveTo investigate the application of stereoelectroencephalography (SEEG) in the refractory epilepsy related to periventricular nodular heterotopia (PNH). MethodsTen patients with drug-resistant epilepsy related to PNHs from Guangdong Sanjiu Brain Hospital and the First Affiliated Hospital of Jinan University from April 2017 to February 2021 were studied. Electrodes were implanted based on non-invasive preoperative evaluation. Then long-term monitoring of SEEG was carried out. The patterns of epileptogenic zone (EZ) were divided into four categories based on the ictal SEEG: A. only the nodules started; B. nodules and cortex synchronous initiation; C. the cortex initiation with early spreading to nodules; D. only cortex initiation. All patients underwent SEEG-guided radiofrequency thermocoagulation (RFTC), with a follow-up of at least 12 months. ResultsAll cases were multiple nodules. Four cases were unilateral and six bilateral. Eight cases were distributed in posterior pattern, and one in anterior pattern and one in diffused pattern, respectively. Seven patients had only PNH (pure PNH) and three patients were associated with other overlying cortex malformations (PNH plus). The EZ patterns of all cases were confirmed by the ictal SEEG: six patients were in pure type A, two patients were in pure type B, one patient in type A+B and one in type A+B+C, respectively. In eight patients SEEG-guided RF-TC was targeted only to PNHs; and in two patients RFTC was directed to both heterotopias and related cortical regions. The mean follow up was (33.4±14.0) months (12 ~ 58 months). Eight patients (in pure type A or type A included) were seizure free. Two patients were effective. None of the patients had significant postoperative complications or sequelae. ConclusionThe epileptic network of Epilepsy associated with nodular heterotopia may be individualized. Not all nodules are always epileptogenic, the role of each nodule in the epileptic network may be different. And multiple epileptic patterns may occur simultaneously in the same patient. SEEG can provide individualized diagnosis and treatment, be helpful to prognosis.
ObjectiveTo investigate the efficacy and safety of Stereotactic electroencephalogram (SEEG)-guided Radiofrequency-thermocoagulation (RF-TC) in the treatment of refractory insular epilepsy in children.MethodsThe clinical data of 7 children with SEEG-confirmed insular epilepsy admitted to the Epilepsy Center of the Children’s Hospital Affiliated to Shandong University from January 2021 to May 2022, were retrospectively analyzed (3 males and 4 females; average age, 6.6±3.5 years). All patients underwent stage I pre-operative evaluation, and were implanted with SEEG electrodes for video EEG monitoring. The radiofrequency thermocoagulation contacts were determined according to SEEG and imaging results, and radiofrequency thermocoagulation was performed via electrode contacts. The patients were followed up at 3, 6, 12 and 18 months after operation by outpatient review or via telephone interview. The clinical efficacy was evaluated by Engel classification and complications were recorded. ResultsSix cases (6/7) were characterized by nocturnal seizures, and four cases (4/7) exhibited hypermotor or complex motor seizures. Three cases (3/7) showed focal ankylosis; only 1 patient had aura. All of the 7 cases showed interictal scalp EEG consistent with the side of surgery: 6 cases showed distribution in the perilateral fissure region, and 1 case showed confinement to the temporal region. In MRI, 4 cases showed negative signal, 2 cases showed unclear gray-white matter boundary, and 1 case showed thickening of the insular cortex. All of the 7 patients received electrode implantation and completed follow-up for over 6 months [6.0~22.0 (12.3±5.3) months]. At the last follow-up, 5 of the 7 children were seizure free (Engel class la), and 2 still had seizures after surgery, with no postoperative long-term complications.ConclusionChildren with insular epilepsy rarely show an aura, but have prominent motor symptoms, and the scalp electroencephalogram is mainly distributed in the perilateral fissured area. SEEG-guided RF-TC has good safety and efficacy in the treatment of drug‐resistant insular epilepsy.
ObjectiveTo preliminarily explore the damage effect of stereo electroencephalogram-guided radiofrequency thermocoagulation after increasing the number of electrodes in the epileptic foci.MethodsEight cases were included from 42 patients requiring SEEG from the Department of Neurosurgery of the Second Hospital of Lanzhou University during June 2017 to Jan. 2019, of which 6 cases were hypothetical epileptogenic foci located in the functional area or deep in the epileptogenic foci that could not be surgically removed, 2 patients who were unwilling to undergo craniotomy; added hypothetical epileptic foci Electrodes, the number of implanted electrodes exceeds the number of electrodes needed to locate the epileptic foci. After radiofrequency thermocoagulation damages the epileptogenic foci, the therapeutic effect is analyzed.ResultsIn 8 patients, the number of implanted electrodes increased from 1 ~ 6, with an average of (4±2.2), and the number of thermosetting points increased by 2 ~ 10, with an average of (7±3.1); follow-up (9±3.2) months, Epilepsy control status: 3 cases of Engel Ⅰ, 3 cases of Engel Ⅱ, 2 cases of Engel Ⅲ; 8 cases of epileptic seizure frequency decreased≥50%. There was a statistically significant difference in the frequency of attacks before and after thermocoagulation (P<0.05).ConclusionsIncreasing the lesion volume of the epileptic foci can obviously improve the efficacy of epilepsy. SEEG-guided radiofrequency thermocoagulation is an effective supplementary method for classical resection.
ObjectiveTo explore the advantages and disadvantages of using two intracranial EEG (iEEG) monitoring methods—Subdural ectrodes electroencephalography (SDEG)and Stereoelectroencephalography (SEEG), in patients with “difficult to locate” Intractable Epilepsy. MethodsRetrospectively analyzed the data of 60 patients with SDEG monitoring (49 cases) and SEEG monitoring (11 cases) from January 2010 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical. Observe and statistically compare the differences in the evaluation results of epileptic zones, surgical efficacy and related complications of the two groups of patients, and review the relevant literature. ResultsThe results showed that the two groups of SDEG and SEEG had no significant difference in the positive rate and surgical resection rate of epileptogenic zones, but the bilateral implantation rate of SEEG (5/11, 45.5%) was higher than that of SDEG (18/49, 36.7%). At present, there was no significant difference in the postoperative outcome among patients with epileptic zones resected after SDEG and SEEG monitoring (P>0.05). However, due to the limitation of the number of SEEG cases, it is not yet possible to conclude that the two effects were the same. There was a statistically significant difference in the total incidence of serious complications of bleeding or infection between the two groups (SDEG 20 cases vs. SEEG 1 case, P<0.05). There was a statistically significant difference in the total incidence of significant headache or cerebral edema between the two groups (SDEG 26 cases vs. SEEG 2 cases, P<0.05). There was a statistically significant difference in the incidence of cerebrospinal fluid leakage, subcutaneous fluid incision, and poor healing of incision after epileptic resection (SDEG 14 cases vs. SEEG 0 case, P<0.05); there were no significant differences in dysfunction of speech, muscle strength between the two groups (P>0.05). ConclusionSEEG has fewer complications than SDEG, SEEG is safer than SDEG. The two kinds of iEEG monitoring methods have advantages in the localization of epileptogenic zones and the differentiation of functional areas. The effective combination of the two methods in the future may be more conducive to the location of epileptic zones and functional areas.