TY - JOUR
T1 - Diagnostic utility of invasive EEG for epilepsy surgery
T2 - Indications, modalities, and techniques
AU - Jayakar, Prasanna
AU - Gotman, Jean
AU - Harvey, A. Simon
AU - Palmini, André
AU - Tassi, Laura
AU - Schomer, Donald
AU - Dubeau, Francois
AU - Bartolomei, Fabrice
AU - Yu, Alice
AU - Kršek, Pavel
AU - Velis, Demetrios
AU - Kahane, Philippe
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.
AB - Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.
KW - Epilepsy surgery
KW - Indications
KW - Intracranial EEG
KW - Utility
UR - http://www.scopus.com/inward/record.url?scp=84994430952&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/epi.13515
DO - https://doi.org/10.1111/epi.13515
M3 - Article
C2 - 27677490
SN - 0013-9580
VL - 57
SP - 1735
EP - 1747
JO - Epilepsia
JF - Epilepsia
IS - 11
ER -