Lepard Jacob R, Dupépé Esther, Davis Matthew, DeWolfe Jennifer, Agee Bonita, Bentley J Nicole, Riley Kristen
Departments of1Neurosurgery and.
2Neurology, University of Alabama at Birmingham, Alabama.
J Neurosurg. 2021 May 28;135(6):1765-1770. doi: 10.3171/2020.10.JNS201629. Print 2021 Dec 1.
Invasive monitoring has long been utilized in the evaluation of patients for epilepsy surgery, providing localizing information to guide resection. Stereoelectroencephalography (SEEG) was introduced at the authors' level 4 epilepsy surgery program in 2013, with responsive neurostimulation (RNS) becoming available the following year. The authors sought to characterize patient demographics and epilepsy-related variables before and after SEEG introduction to understand whether differences emerged in their patient population. This information will be useful in understanding how SEEG, possibly in conjunction with RNS availability, may have changed practice patterns over time.
This is a retrospective cohort study of consecutive patients who underwent surgery for epilepsy from 2006 to 2018, comprising 7 years before and 5 years after the introduction of SEEG. The authors performed univariate analyses of patient characteristics and outcomes and used generalized estimating equations logistic regression for predictive analysis.
A total of 178 patients were analyzed, with 109 patients in the pre-SEEG cohort and 69 patients in the post-SEEG cohort. In the post-SEEG cohort, more patients underwent invasive monitoring for suspected bilateral seizure onsets (40.6% vs 22.0%, p = 0.01) and extratemporal seizure onsets (68.1% vs 8.3%, p < 0.0001). The post-SEEG cohort had a higher proportion of patients with seizures arising from eloquent cortex (14.5% vs 0.9%, p < 0.001). Twelve patients underwent RNS insertion in the post-SEEG group versus none in the pre-SEEG group. Fewer patients underwent resection in the post-SEEG group (55.1% vs 96.3%, p < 0.0001), but there was no significant difference in rates of seizure freedom between cohorts for those patients having undergone a follow-up resection (53.1% vs 59.8%, p = 0.44).
These findings demonstrate that more patients with suspected bilateral, eloquent, or extratemporal epilepsy underwent invasive monitoring after adoption of SEEG. This shift occurred coincident with the adoption of RNS, both of which likely contributed to increased patient complexity. The authors conclude that their practice now considers invasive monitoring for patients who likely would not previously have been candidates for surgical investigation and subsequent intervention.
侵入性监测长期以来一直用于癫痫手术患者的评估，提供定位信息以指导切除手术。立体定向脑电图（SEEG）于2013年被引入作者所在的4级癫痫手术项目，次年响应性神经刺激（RNS）开始应用。作者试图描述引入SEEG前后患者的人口统计学特征和癫痫相关变量，以了解患者群体中是否出现差异。这些信息将有助于理解SEEG（可能与RNS的应用相结合）如何随时间改变了实践模式。
这是一项对2006年至2018年连续接受癫痫手术患者的回顾性队列研究，包括引入SEEG之前的7年和之后的5年。作者对患者特征和结局进行了单因素分析，并使用广义估计方程逻辑回归进行预测分析。
共分析了178例患者，其中SEEG前队列有109例患者，SEEG后队列有69例患者。在SEEG后队列中，更多患者因怀疑双侧发作起始（40.6%对22.0%，p = 0.01）和颞外发作起始（68.1%对8.3%，p < 0.0001）而接受侵入性监测。SEEG后队列中因明确皮层发作的患者比例更高（14.5%对0.9%，p < 0.001）。SEEG后组有12例患者接受了RNS植入，而SEEG前组无患者接受。SEEG后组接受切除手术的患者较少（55.1%对96.3%，p < 0.0001），但在接受后续切除手术的患者中，两组间无癫痫发作缓解率的显著差异（53.1%对59.8%，p = 0.44）。
这些发现表明，在采用SEEG后，更多怀疑双侧、明确或颞外癫痫的患者接受了侵入性监测。这种转变与RNS的采用同时发生，两者都可能导致患者病情复杂性增加。作者得出结论，他们现在的实践考虑对以前可能不符合手术检查和后续干预条件的患者进行侵入性监测。
