Comparison of outcomes after stereoelectroencephalography and subdural grid monitoring in pediatric tuberous sclerosis complex.

Autor:	Larrew T; 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.; 2Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati., Skoch J; 2Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati., Ihnen SKZ; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Arya R; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Holland KD; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Tenney JR; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Horn PS; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Leach JL; 5Division of Pediatric Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Krueger DA; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Greiner HM; 3Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati.; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati; and., Mangano FT; 2Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2022 Oct; Vol. 53 (4), pp. E5.
DOI:	10.3171/2022.7.FOCUS22335
Abstrakt:	Objective: Patients with tuberous sclerosis complex (TSC) epilepsy present with unique clinical challenges such as early seizure onset and high rates of intractability and multifocality. Although there are numerous studies about the safety and efficacy of stereoelectroencephalography (SEEG), this topic has not been studied in TSC patients who have distinct epilepsy profiles. The authors investigated subdural grid (SDG) and SEEG monitoring to determine whether these procedures lead to similar seizure and safety outcomes and to identify features unique to this pediatric population. Methods: TSC patients who underwent SDG or SEEG placement and a second epilepsy surgery during the period from 2007 to 2021 were included in this single-center retrospective cohort analysis. Various patient, hospitalization, and epilepsy characteristics were collected. Results: A total of 50 TSC patients were included in this study: 30 were included in the SDG cohort and 20 in the SEEG cohort. Baseline weekly seizure count did not significantly differ between the 2 groups (p = 0.412). The SEEG group had a greater mean baseline number of antiepileptic drugs (AEDs) (3.0 vs 2.0, p = 0.003), higher rate of previous surgical interventions (25% vs 0%, p = 0.007), and larger proportion of patients who underwent bilateral monitoring (50% vs 13.3%, p = 0.005). Despite this, there was no significant difference in seizure freedom between the SDG and SEEG cohorts. The mean reduction in seizure count was 84.9% and 47.8% of patients were seizure free at last follow-up (mean 79.4 months). SEEG trended toward being a safer procedure than SDG monitoring, with a shorter mean ICU stay (0.7 days vs 3.9 days, p < 0.001), lower blood transfusion rate (0% vs 13.3%, p = 0.140), and lower surgical complication rate (0% vs 10%, p = 0.265). Conclusions: In the comparison of the SDG and SEEG cohorts, the SEEG group included patients who appeared to receive more aggressive management and have a higher rate of multifocality, more prior surgical interventions, more AEDs at baseline, and a higher rate of bilateral invasive monitoring. Despite this, the SEEG cohort had similar seizure outcomes and a trend toward increased safety. Based on these findings, SEEG appears to allow for monitoring of a wider breadth of TSC patients given its minimally invasive nature and its relative simplicity for monitoring numerous regions of the brain.
Databáze:	MEDLINE
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