Comparative Effectiveness of Stereo-EEG versus Subdural Grids in Epilepsy Surgery
AUTHORS
- PMID: 34590337 [PubMed].
ABSTRACT
OBJECTIVE: To compare the outcomes of subdural electrode (SDE) implantations versus stereo-electroencephalography (SEEG), the two predominant methods of intracranial EEG (iEEG) performed in difficult to localize drug-resistant focal epilepsy.
METHODS: The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005-2019 with ≥ 1 year follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints: 1) likelihood of resection after iEEG; 2) seizure-freedom at last follow-up; and 3) complications (composite of either post-operative infection, symptomatic intracranial hemorrhage, or permanent neurologic deficit).
RESULTS: Ten study sites from seven countries and three continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE, 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% 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 to SDE (unadjusted: 55% seizure-free after SEEG-guided resections vs. 41% after SDE) INTERPRETATION: Compared 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. This article is protected by copyright. All rights reserved.
Tags: alumni publications 2021