Subdural strip electrode monitoring and surgical decision making in refractory epilepsy: validity and prognostic value of noninvasive localizing data

Martin E Weinand, Waleed F. El-Saadany, David M Labiner, Dinesh Talwar, Geoffrey L Ahern

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

We analyzed the rationale for invasive monitoring in refractory epilepsy. In 54 selected patients, video/scalp-EEG was insufficient for seizure focus localization. Therefore, bilateral subdural electrodes were implanted for ictal recording. In 40 (74.1%) of 54 patients, ictal electrocorticography (ECoG) localized a seizure focus amenable to resection. Fourteen (25.9%) of 54 patients, had multiple foci or primary generalized seizures. Among 36 patients who had focal resection with at least 1-year follow-up, 32 (88.9%) are either seizure-free or significantly improved. Magnetic resonance imaging (MRI) and interictal single photon emission computed tomography (SPECT) had the highest sensitivity and specificity (80.0 and 81.8%, respectively) and the greatest diagnostic value (64.0 and 77.8%, respectively) for seizure focus localization. Independent of electrophysiologic data, MRI determination of focal abnormality was prognostic for seizure-free outcome. Concordance of one or more noninvasive techniques with ictal ECoG seizure focus localization was statistically significant in predicting seizure-free outcome. Although interest in noninvasive selection of candidates for focal resection is increasing, there remains a role for invasive monitoring of epileptogenic foci that are difficult to localize. Our study should improve selection of patients with refractory epilepsy for focal resection when ictal ECoG is used in conjunction with noninvasive data for surgical decision making.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalJournal of Epilepsy
Volume8
Issue number2
DOIs
StatePublished - 1995

Fingerprint

Epilepsy
Decision Making
Electrodes
Seizures
Stroke
Magnetic Resonance Imaging
Implanted Electrodes
Partial Epilepsy
Single-Photon Emission-Computed Tomography
Scalp
Patient Selection
Electroencephalography
Sensitivity and Specificity
Electrocorticography

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Neuroimaging
  • Subdural electrode

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

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title = "Subdural strip electrode monitoring and surgical decision making in refractory epilepsy: validity and prognostic value of noninvasive localizing data",
abstract = "We analyzed the rationale for invasive monitoring in refractory epilepsy. In 54 selected patients, video/scalp-EEG was insufficient for seizure focus localization. Therefore, bilateral subdural electrodes were implanted for ictal recording. In 40 (74.1{\%}) of 54 patients, ictal electrocorticography (ECoG) localized a seizure focus amenable to resection. Fourteen (25.9{\%}) of 54 patients, had multiple foci or primary generalized seizures. Among 36 patients who had focal resection with at least 1-year follow-up, 32 (88.9{\%}) are either seizure-free or significantly improved. Magnetic resonance imaging (MRI) and interictal single photon emission computed tomography (SPECT) had the highest sensitivity and specificity (80.0 and 81.8{\%}, respectively) and the greatest diagnostic value (64.0 and 77.8{\%}, respectively) for seizure focus localization. Independent of electrophysiologic data, MRI determination of focal abnormality was prognostic for seizure-free outcome. Concordance of one or more noninvasive techniques with ictal ECoG seizure focus localization was statistically significant in predicting seizure-free outcome. Although interest in noninvasive selection of candidates for focal resection is increasing, there remains a role for invasive monitoring of epileptogenic foci that are difficult to localize. Our study should improve selection of patients with refractory epilepsy for focal resection when ictal ECoG is used in conjunction with noninvasive data for surgical decision making.",
keywords = "Epilepsy, Epilepsy surgery, Neuroimaging, Subdural electrode",
author = "Weinand, {Martin E} and El-Saadany, {Waleed F.} and Labiner, {David M} and Dinesh Talwar and Ahern, {Geoffrey L}",
year = "1995",
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T1 - Subdural strip electrode monitoring and surgical decision making in refractory epilepsy

T2 - validity and prognostic value of noninvasive localizing data

AU - Weinand, Martin E

AU - El-Saadany, Waleed F.

AU - Labiner, David M

AU - Talwar, Dinesh

AU - Ahern, Geoffrey L

PY - 1995

Y1 - 1995

N2 - We analyzed the rationale for invasive monitoring in refractory epilepsy. In 54 selected patients, video/scalp-EEG was insufficient for seizure focus localization. Therefore, bilateral subdural electrodes were implanted for ictal recording. In 40 (74.1%) of 54 patients, ictal electrocorticography (ECoG) localized a seizure focus amenable to resection. Fourteen (25.9%) of 54 patients, had multiple foci or primary generalized seizures. Among 36 patients who had focal resection with at least 1-year follow-up, 32 (88.9%) are either seizure-free or significantly improved. Magnetic resonance imaging (MRI) and interictal single photon emission computed tomography (SPECT) had the highest sensitivity and specificity (80.0 and 81.8%, respectively) and the greatest diagnostic value (64.0 and 77.8%, respectively) for seizure focus localization. Independent of electrophysiologic data, MRI determination of focal abnormality was prognostic for seizure-free outcome. Concordance of one or more noninvasive techniques with ictal ECoG seizure focus localization was statistically significant in predicting seizure-free outcome. Although interest in noninvasive selection of candidates for focal resection is increasing, there remains a role for invasive monitoring of epileptogenic foci that are difficult to localize. Our study should improve selection of patients with refractory epilepsy for focal resection when ictal ECoG is used in conjunction with noninvasive data for surgical decision making.

AB - We analyzed the rationale for invasive monitoring in refractory epilepsy. In 54 selected patients, video/scalp-EEG was insufficient for seizure focus localization. Therefore, bilateral subdural electrodes were implanted for ictal recording. In 40 (74.1%) of 54 patients, ictal electrocorticography (ECoG) localized a seizure focus amenable to resection. Fourteen (25.9%) of 54 patients, had multiple foci or primary generalized seizures. Among 36 patients who had focal resection with at least 1-year follow-up, 32 (88.9%) are either seizure-free or significantly improved. Magnetic resonance imaging (MRI) and interictal single photon emission computed tomography (SPECT) had the highest sensitivity and specificity (80.0 and 81.8%, respectively) and the greatest diagnostic value (64.0 and 77.8%, respectively) for seizure focus localization. Independent of electrophysiologic data, MRI determination of focal abnormality was prognostic for seizure-free outcome. Concordance of one or more noninvasive techniques with ictal ECoG seizure focus localization was statistically significant in predicting seizure-free outcome. Although interest in noninvasive selection of candidates for focal resection is increasing, there remains a role for invasive monitoring of epileptogenic foci that are difficult to localize. Our study should improve selection of patients with refractory epilepsy for focal resection when ictal ECoG is used in conjunction with noninvasive data for surgical decision making.

KW - Epilepsy

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KW - Neuroimaging

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