Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

Lara Jehi; Marcia Morita-Sherman; Thomas E. Love; Fabrice Bartolomei; William Bingaman; Kees Braun; Robyn M. Busch; John Duncan; Walter J. Hader; Guoming Luan; John D. Rolston; Stephan Schuele; Laura Tassi; Sumeet Vadera; Shehryar Sheikh; Imad Najm; Amir Arain; Justin Bingaman; Beate Diehl; Jane de Tisi; Matea Rados; Pieter Van Eijsden; Sandra Wahby; Xiongfei Wang; Samuel Wiebe

doi:10.1002/ana.26238

Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

Lara Jehi^*, Marcia Morita-Sherman, Thomas E. Love, Fabrice Bartolomei, William Bingaman, Kees Braun, Robyn M. Busch, John Duncan, Walter J. Hader, Guoming Luan, John D. Rolston, Stephan Schuele, Laura Tassi, Sumeet Vadera, Shehryar Sheikh, Imad Najm, Amir Arain, Justin Bingaman, Beate Diehl, Jane de TisiMatea Rados, Pieter Van Eijsden, Sandra Wahby, Xiongfei Wang, Samuel Wiebe

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

Objective: 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. Methods: 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). Results: 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). Interpretation: 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.

Original language	English
Pages (from-to)	927-939
Number of pages	13
Journal	Annals of Neurology
Volume	90
Issue number	6
DOIs	https://doi.org/10.1002/ana.26238
Publication status	Published - Dec 2021

Keywords

Adult
Brain Mapping/methods
Electrodes, Implanted
Electroencephalography/methods
Epilepsy/surgery
Female
Humans
Male
Middle Aged
Neurosurgical Procedures/methods
Seizures/surgery
Stereotaxic Techniques
Treatment Outcome
Young Adult

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10.1002/ana.26238

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Jehi, L., Morita-Sherman, M., Love, T. E., Bartolomei, F., Bingaman, W., Braun, K., Busch, R. M., Duncan, J., Hader, W. J., Luan, G., Rolston, J. D., Schuele, S., Tassi, L., Vadera, S., Sheikh, S., Najm, I., Arain, A., Bingaman, J., Diehl, B., ... Wiebe, S. (2021). Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery. Annals of Neurology, 90(6), 927-939. https://doi.org/10.1002/ana.26238

@article{b3d2e9e8899f47c59291d1ac0d693b20,

title = "Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery",

abstract = "Objective: 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. Methods: 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). Results: 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). Interpretation: 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.",

keywords = "Adult, Brain Mapping/methods, Electrodes, Implanted, Electroencephalography/methods, Epilepsy/surgery, Female, Humans, Male, Middle Aged, Neurosurgical Procedures/methods, Seizures/surgery, Stereotaxic Techniques, Treatment Outcome, Young Adult",

author = "Lara Jehi and Marcia Morita-Sherman and Love, {Thomas E.} and Fabrice Bartolomei and William Bingaman and Kees Braun and Busch, {Robyn M.} and John Duncan and Hader, {Walter J.} and Guoming Luan and Rolston, {John D.} and Stephan Schuele and Laura Tassi and Sumeet Vadera and Shehryar Sheikh and Imad Najm and Amir Arain and Justin Bingaman and Beate Diehl and {de Tisi}, Jane and Matea Rados and {Van Eijsden}, Pieter and Sandra Wahby and Xiongfei Wang and Samuel Wiebe",

note = "Funding Information: This project received funding from the International League Against Epilepsy (funding of statistical analysis) and National Institute of Neurological Disorders and Stroke (number R01NS097719; effort for data collection in Cleveland Clinic). Some of the data reported in this paper were collected as part of a project undertaken by the International League against Epilepsy (ILAE), and some of the authors are experts selected by the ILAE. Opinions expressed by the authors, however, do not necessarily represent the policy or position of the ILAE. Funding Information: This project received funding from the International League Against Epilepsy (funding of statistical analysis) and National Institute of Neurological Disorders and Stroke (number R01NS097719; effort for data collection in Cleveland Clinic). Some of the data reported in this paper were collected as part of a project undertaken by the International League against Epilepsy (ILAE), and some of the authors are experts selected by the ILAE. Opinions expressed by the authors, however, do not necessarily represent the policy or position of the ILAE. Publisher Copyright: {\textcopyright} 2021 American Neurological Association.",

year = "2021",

month = dec,

doi = "10.1002/ana.26238",

language = "English",

volume = "90",

pages = "927--939",

journal = "Annals of Neurology",

issn = "0364-5134",

publisher = "John Wiley & Sons Inc.",

number = "6",

}

Jehi, L, Morita-Sherman, M, Love, TE, Bartolomei, F, Bingaman, W, Braun, K, Busch, RM, Duncan, J, Hader, WJ, Luan, G, Rolston, JD, Schuele, S, Tassi, L, Vadera, S, Sheikh, S, Najm, I, Arain, A, Bingaman, J, Diehl, B, de Tisi, J, Rados, M, Van Eijsden, P, Wahby, S, Wang, X & Wiebe, S 2021, 'Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery', Annals of Neurology, vol. 90, no. 6, pp. 927-939. https://doi.org/10.1002/ana.26238

TY - JOUR

T1 - Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

AU - Jehi, Lara

AU - Morita-Sherman, Marcia

AU - Love, Thomas E.

AU - Bartolomei, Fabrice

AU - Bingaman, William

AU - Braun, Kees

AU - Busch, Robyn M.

AU - Duncan, John

AU - Hader, Walter J.

AU - Luan, Guoming

AU - Rolston, John D.

AU - Schuele, Stephan

AU - Tassi, Laura

AU - Vadera, Sumeet

AU - Sheikh, Shehryar

AU - Najm, Imad

AU - Arain, Amir

AU - Bingaman, Justin

AU - Diehl, Beate

AU - de Tisi, Jane

AU - Rados, Matea

AU - Van Eijsden, Pieter

AU - Wahby, Sandra

AU - Wang, Xiongfei

AU - Wiebe, Samuel

N1 - Funding Information: This project received funding from the International League Against Epilepsy (funding of statistical analysis) and National Institute of Neurological Disorders and Stroke (number R01NS097719; effort for data collection in Cleveland Clinic). Some of the data reported in this paper were collected as part of a project undertaken by the International League against Epilepsy (ILAE), and some of the authors are experts selected by the ILAE. Opinions expressed by the authors, however, do not necessarily represent the policy or position of the ILAE. Funding Information: This project received funding from the International League Against Epilepsy (funding of statistical analysis) and National Institute of Neurological Disorders and Stroke (number R01NS097719; effort for data collection in Cleveland Clinic). Some of the data reported in this paper were collected as part of a project undertaken by the International League against Epilepsy (ILAE), and some of the authors are experts selected by the ILAE. Opinions expressed by the authors, however, do not necessarily represent the policy or position of the ILAE. Publisher Copyright: © 2021 American Neurological Association.

PY - 2021/12

Y1 - 2021/12

N2 - Objective: 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. Methods: 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). Results: 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). Interpretation: 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.

AB - Objective: 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. Methods: 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). Results: 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). Interpretation: 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.

KW - Adult

KW - Brain Mapping/methods

KW - Electrodes, Implanted

KW - Electroencephalography/methods

KW - Epilepsy/surgery

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neurosurgical Procedures/methods

KW - Seizures/surgery

KW - Stereotaxic Techniques

KW - Treatment Outcome

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85117008715&partnerID=8YFLogxK

U2 - 10.1002/ana.26238

DO - 10.1002/ana.26238

M3 - Article

C2 - 34590337

AN - SCOPUS:85117008715

SN - 0364-5134

VL - 90

SP - 927

EP - 939

JO - Annals of Neurology

JF - Annals of Neurology

IS - 6

ER -

Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

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