Results Of the 260 cases included in the study (54.6% female mean age at evaluation, 30.3 years), the SEEG (n = 121) and SDE (n = 139) groups were similar in age (mean, 30.1 vs 30.6 years), sex (47.1% vs 43.9% male), numbers of failed anticonvulsants (mean, 5.7 vs 5.6 ), and duration of epilepsy (mean, 16.4 vs17.2 years). Main Outcomes and Measures Length of surgical procedure, surgical complications, opiate use, and seizure outcomes using the Engel Epilepsy Surgery Outcome Scale. Interventions Implantation of SDE using standard techniques vs SEEG using a stereotactic robot, followed by resection or laser ablation of the seizure focus. Procedures were performed from November 1, 2004, through June 30, 2017, and data were analyzed in June 2017 and August 2018.
Objective To perform a comparative analysis of the relative efficacy, procedural morbidity, and epilepsy outcomes consequent to SEEG and SDE in similar patient populations and performed by a single surgeon at 1 center.ĭesign, Setting and Participants Overall, 239 patients with medically intractable epilepsy underwent 260 consecutive intracranial electroencephalographic procedures to localize their epilepsy. However, the comparative morbidity and outcomes of this minimally invasive procedure relative to traditional subdural electrode (SDE) implantation are unknown. Importance A major change has occurred in the evaluation of epilepsy with the availability of robotic stereoelectroencephalography (SEEG) for seizure localization. Meaning Stereoelectroencephalography has distinctly better procedural morbidities and, in selected cases, may have better outcomes than subdural grid electrodes, features that should influence decision making and lower the barrier to candidacy for resection or ablation among patients with intractable epilepsy. Despite being less likely to have lesions on magnetic resonance imaging, patients who had definitive procedures had better outcomes at 1 year if they underwent evaluation using stereoelectroencephalography (57 of 75 ) compared with subdural grid electrode evaluation (59 of 108 ). Question Does stereoelectroencephalography change the landscape around the management of medically intractable epilepsy?įindings This comparative analysis of 239 patients undergoing 260 consecutive intracranial evaluations of intractable epilepsy found that stereoelectroencephalography implantation took less time and was less painful and less morbid for patients compared with subdural electrode implantations. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.
Challenges in Clinical Electrocardiography.