The role of intracranial electrode reevaluation in epilepsy patients after failed initial invasive monitoring

Adrian M. Siegel, David W. Roberts, Vijay M. Thadani, James McInerney, Barbara C. Jobst, Peter D. Williamson

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Purpose: Intracranial electrode recording often provides localization of the site of seizure onset to allow epilepsy surgery. In patients whose invasive evaluation fails to localize seizure origin, the utility of further invasive monitoring is unknown. This study was undertaken to explore the hypothesis that a second intracranial investigation is selected patients warrants consideration and can lead to successful epilepsy surgery. Methods: A series of 110 consecutive patients with partial epilepsy who had undergone intracranial electrode evaluation (by subdural strip, subdural grid, and/or depth electrodes) between February 1992 and October 1998 was retrospectively analyzed. Of these, failed localization of seizure origin was thought to be due to sampling error in 13 patients. Nine of these 13 patients underwent a second intracranial investigation. Results: Reevaluation with intracranial electrodes resulted in satisfactory seizure-onset localization in seven of nine patients, and these seven had epilepsy surgery. Three frontal, two temporal, and one occipital resection as well as one multiple subpial transection were performed. Six patients have become seizure free, and one was not significantly improved. The mean follow-up is 2.8 years. There was no permanent morbidity. Conclusions: In selected patients in whom invasive monitoring fails to identify the site of seizure origin, reinvestigation with intracranial electrodes can achieve localization of the region of seizure onset and allow successful surgical treatment.

Original languageEnglish (US)
Pages (from-to)571-580
Number of pages10
JournalEpilepsia
Volume41
Issue number5
DOIs
StatePublished - Jan 1 2000

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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