Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery.
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
28
09
2021
received:
04
04
2021
accepted:
28
09
2021
pubmed:
1
10
2021
medline:
15
12
2021
entrez:
30
9
2021
Statut:
ppublish
Résumé
The aim was to compare the outcomes of subdural electrode (SDE) implantations versus stereotactic electroencephalography (SEEG), the 2 predominant methods of intracranial electroencephalography (iEEG) performed in difficult-to-localize drug-resistant focal epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005 and 2019 with ≥1 year of follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints were: (1) likelihood of resection after iEEG; (2) seizure freedom at last follow-up; and (3) complications (composite of postoperative infection, symptomatic intracranial hemorrhage, or permanent neurological deficit). Ten study sites from 7 countries and 3 continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE and 942 SEEG), of whom 988 (67%) underwent subsequent resection. Propensity score matching improved covariate balance between exposure groups for all analyses. Propensity-matched patients who underwent SDE had higher odds of subsequent resective surgery (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.05, 1.84) and higher odds of complications (OR = 2.24, 95% CI 1.34, 3.74; unadjusted: 9.6% after SDE vs 3.3% after SEEG). Odds of seizure freedom in propensity-matched resected patients were 1.66 times higher (95% CI 1.21, 2.26) for SEEG compared with SDE (unadjusted: 55% seizure free after SEEG-guided resections vs 41% after SDE). In comparison to SEEG, SDE evaluations are more likely to lead to brain surgery in patients with drug-resistant epilepsy but have more surgical complications and lower probability of seizure freedom. This comparative-effectiveness study provides the highest feasible evidence level to guide decisions on iEEG. ANN NEUROL 2021;90:927-939.
Identifiants
pubmed: 34590337
doi: 10.1002/ana.26238
pmc: PMC9438788
mid: NIHMS1812979
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
927-939Subventions
Organisme : NINDS NIH HHS
ID : R01 NS097719
Pays : United States
Organisme : NINDS NIH HHS
ID : R01NS097719
Pays : United States
Organisme : International League Against Epilepsy Grant
Informations de copyright
© 2021 American Neurological Association.
Références
Neurosurgery. 2016 Jun;78(6):851-61
pubmed: 26579966
Epilepsy Curr. 2020 Jul;20(4):180-188
pubmed: 32677484
Lancet Neurol. 2015 Mar;14(3):283-90
pubmed: 25638640
Epilepsia. 2019 Sep;60(9):1960-1972
pubmed: 31423575
Neurosurgery. 2017 Apr 1;80(4):505-514
pubmed: 28362926
Acta Neurochir (Wien). 2019 Apr;161(4):627-634
pubmed: 30798479
Neurosurgery. 2020 Jul 1;87(1):E23-E30
pubmed: 32357217
JAMA Neurol. 2019 Jun 1;76(6):672-681
pubmed: 30830149
Brain. 2004 Sep;127(Pt 9):2018-30
pubmed: 15215219
Neurosurgery. 2018 Mar 1;82(3):350-358
pubmed: 28419330
Ann Neurol. 2013 May;73(5):646-54
pubmed: 23494550
N Engl J Med. 2017 Oct 26;377(17):1648-1656
pubmed: 29069555
Epilepsy Behav. 2018 Apr;81:86-93
pubmed: 29526579
J Neurosurg. 2016 Feb;124(2):558-68
pubmed: 26315006
Epilepsy Behav Case Rep. 2018 Jul 17;10:92-95
pubmed: 30112277
Neurology. 2000 Feb 8;54(3):630-4
pubmed: 10680795
Epilepsia. 2020 Mar;61(3):465-478
pubmed: 32108946
J Neurosurg Pediatr. 2013 Aug;12(2):126-33
pubmed: 23768201
Epilepsia. 2015 Oct;56(10):1526-33
pubmed: 26250432
Epilepsia. 2008 Aug;49(8):1308-16
pubmed: 18754943
Lancet. 2011 Dec 10;378(9808):2028-2038
pubmed: 21737136
Epilepsia. 2016 Nov;57(11):1735-1747
pubmed: 27677490
Epilepsia. 2013 May;54(5):840-7
pubmed: 23551133
Neurology. 2015 Oct 27;85(17):1475-81
pubmed: 26408491
J Clin Neurosci. 2018 Jul;53:132-134
pubmed: 29724650
Brain. 2007 Feb;130(Pt 2):574-84
pubmed: 17209228
Neurotherapeutics. 2019 Jan;16(1):59-66
pubmed: 30652253
Neurology. 2006 Jun 27;66(12):1938-40
pubmed: 16801667
Epilepsia. 2021 Jan;62(1):74-84
pubmed: 33236777
Epilepsia. 2012 Oct;53(10):1722-30
pubmed: 22905787
Epilepsia. 2017 Dec;58(12):2133-2142
pubmed: 28994113
Epilepsy Behav. 2020 Mar;104(Pt A):106905
pubmed: 32028127
Brain. 2019 Sep 1;142(9):2688-2704
pubmed: 31305885
J Neurol. 2007 Aug;254(8):996-9
pubmed: 17486287
Epilepsia. 2013 Feb;54(2):323-30
pubmed: 23016576
Handb Clin Neurol. 2019;161:45-71
pubmed: 31307620