Incomplete resection of the intracranial electroencephalographic seizure onset zone is not associated with postsurgical outcomes
Delineation of seizure onset regions using intracranial electroencephalography (icEEG) is vital in the surgical workup of drug‐resistant epilepsy cases. However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2024-09, Vol.65 (9), p.e163-e169 |
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| creator | Gascoigne, Sarah J. Evans, Nathan Hall, Gerard Kozma, Csaba Panagiotopoulou, Mariella Schroeder, Gabrielle M. Simpson, Callum Thornton, Christopher Turner, Frances Woodhouse, Heather Blickwedel, Jess Chowdhury, Fahmida A. Diehl, Beate Duncan, John S. Faulder, Ryan Thomas, Rhys H. Wilson, Kevin Taylor, Peter N. Wang, Yujiang |
| description | Delineation of seizure onset regions using intracranial electroencephalography (icEEG) is vital in the surgical workup of drug‐resistant epilepsy cases. However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] |
| doi_str_mv | 10.1111/epi.18061 |
| format | Article |
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However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] < .7). Investigating the spatial extent of onset regions, we found no substantial evidence of an association with postsurgical seizure control (all AUC < .7). Although seizure onset regions are typically resected completely or in large part, incomplete resection is not associated with worse postsurgical outcomes. We conclude that postsurgical seizure recurrence cannot be attributed to an incomplete resection of the icEEG SOZ alone. Other network mechanisms beyond icEEG seizure onset likely contribute.</description><identifier>ISSN: 0013-9580</identifier><identifier>ISSN: 1528-1167</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/epi.18061</identifier><identifier>PMID: 38990082</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Convulsions & seizures ; Drug Resistant Epilepsy - diagnosis ; Drug Resistant Epilepsy - physiopathology ; Drug Resistant Epilepsy - surgery ; EEG ; Electrocorticography - methods ; Electroencephalography - methods ; Epilepsy ; epilepsy surgery ; Female ; Humans ; intracranial EEG ; Male ; Middle Aged ; onset detection ; Retrospective Studies ; seizure freedom ; Seizures ; Seizures - diagnosis ; Seizures - physiopathology ; Seizures - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Epilepsia (Copenhagen), 2024-09, Vol.65 (9), p.e163-e169</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.</rights><rights>2024 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] < .7). Investigating the spatial extent of onset regions, we found no substantial evidence of an association with postsurgical seizure control (all AUC < .7). Although seizure onset regions are typically resected completely or in large part, incomplete resection is not associated with worse postsurgical outcomes. We conclude that postsurgical seizure recurrence cannot be attributed to an incomplete resection of the icEEG SOZ alone. 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However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] < .7). Investigating the spatial extent of onset regions, we found no substantial evidence of an association with postsurgical seizure control (all AUC < .7). Although seizure onset regions are typically resected completely or in large part, incomplete resection is not associated with worse postsurgical outcomes. We conclude that postsurgical seizure recurrence cannot be attributed to an incomplete resection of the icEEG SOZ alone. Other network mechanisms beyond icEEG seizure onset likely contribute.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38990082</pmid><doi>10.1111/epi.18061</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1013-1875</orcidid><orcidid>https://orcid.org/0000-0003-2278-5227</orcidid><orcidid>https://orcid.org/0000-0002-6896-854X</orcidid><orcidid>https://orcid.org/0000-0002-5212-7850</orcidid><orcidid>https://orcid.org/0000-0002-4847-6273</orcidid><orcidid>https://orcid.org/0000-0003-2062-8623</orcidid><orcidid>https://orcid.org/0000-0002-9783-3193</orcidid><orcidid>https://orcid.org/0000-0003-2144-9838</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Convulsions & seizures Drug Resistant Epilepsy - diagnosis Drug Resistant Epilepsy - physiopathology Drug Resistant Epilepsy - surgery EEG Electrocorticography - methods Electroencephalography - methods Epilepsy epilepsy surgery Female Humans intracranial EEG Male Middle Aged onset detection Retrospective Studies seizure freedom Seizures Seizures - diagnosis Seizures - physiopathology Seizures - surgery Treatment Outcome Young Adult |
| title | Incomplete resection of the intracranial electroencephalographic seizure onset zone is not associated with postsurgical outcomes |
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