The characteristics of insular epilepsy in children and analysis of the efficacy and safety of radiofrequency thermocoagulation guided by Stereotactic electroencephalogram_Journal of Epilepsy

Authors：

ZHANG Hongwei , GENG Guifu , GAO Zaifen , CHEN Chuanmei , MENG Yao , HU Wandong , ZHANG Huan , SHI Jianguo ,  LIU Yong

Epilepsy Center, Children’s Hospital Affiliated to Shandong University (Jinan Children’s Hospital), Jinan 250022, China;

Corresponding?author：

LIU Yong, Email: etyyliuyong@163.com

Keywords：

Children; Insular Epilepsy; Stereotactic electroencephalogram; Radiofrequency thermocoagulation

DOI：

10.7507/2096-0247.202211009

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Objective To investigate the efficacy and safety of Stereotactic electroencephalogram (SEEG)-guided Radiofrequency-thermocoagulation (RF-TC) in the treatment of refractory insular epilepsy in children.Methods The clinical data of 7 children with SEEG-confirmed insular epilepsy admitted to the Epilepsy Center of the Children’s Hospital Affiliated to Shandong University from January 2021 to May 2022, were retrospectively analyzed (3 males and 4 females; average age, 6.6±3.5 years). All patients underwent stage I pre-operative evaluation, and were implanted with SEEG electrodes for video EEG monitoring. The radiofrequency thermocoagulation contacts were determined according to SEEG and imaging results, and radiofrequency thermocoagulation was performed via electrode contacts. The patients were followed up at 3, 6, 12 and 18 months after operation by outpatient review or via telephone interview. The clinical efficacy was evaluated by Engel classification and complications were recorded. Results Six cases (6/7) were characterized by nocturnal seizures, and four cases (4/7) exhibited hypermotor or complex motor seizures. Three cases (3/7) showed focal ankylosis; only 1 patient had aura. All of the 7 cases showed interictal scalp EEG consistent with the side of surgery: 6 cases showed distribution in the perilateral fissure region, and 1 case showed confinement to the temporal region. In MRI, 4 cases showed negative signal, 2 cases showed unclear gray-white matter boundary, and 1 case showed thickening of the insular cortex. All of the 7 patients received electrode implantation and completed follow-up for over 6 months [6.0~22.0 (12.3±5.3) months]. At the last follow-up, 5 of the 7 children were seizure free (Engel class la), and 2 still had seizures after surgery, with no postoperative long-term complications.Conclusion Children with insular epilepsy rarely show an aura, but have prominent motor symptoms, and the scalp electroencephalogram is mainly distributed in the perilateral fissured area. SEEG-guided RF-TC has good safety and efficacy in the treatment of drug‐resistant insular epilepsy.

Citation： ZHANG Hongwei, GENG Guifu, GAO Zaifen, CHEN Chuanmei, MENG Yao, HU Wandong, ZHANG Huan, SHI Jianguo, LIU Yong. The characteristics of insular epilepsy in children and analysis of the efficacy and safety of radiofrequency thermocoagulation guided by Stereotactic electroencephalogram. Journal of Epilepsy, 2023, 9(2): 91-95. doi: 10.7507/2096-0247.202211009 Copy

1.	Ryvlin P, Nguyen DK. Insular seizures and epilepsies: ictal semiology and minimal invasive surgery. Curr Opin Neurol, 2021, 34(2): 153-165.
2.	Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
3.	中國醫師協會神經外科分會功能神經外科學組, 中國抗癲癇協會, 國家神經外科手術機器人應用示范項目專家指導委員會. 立體定向腦電圖引導射頻熱凝毀損治療藥物難治性癲癇的中國專家共識. 中華醫學雜志, 2021, 101(29): 7.
4.	Wieser HG, Blume WT, Fish D, et al. ILAE Commission Report. proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia, 2001, 42(2): 282-286.
5.	Isnard J, Guénot M, Sindou M, et al. Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Epilepsia, 2004, 45(9): 1079-1090.
6.	Bouthillier A, Weil AG, Martineau L, et al. Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective? J Neurosurg, 2019, 48: 1-10.
7.	Wang H, McGonigal A, Zhang K, et al. Semiologic subgroups of insulo-opercular seizures based on connectional architecture atlas. Epilepsia, 2020, 61(5): 984-994.
8.	Singh R, Principe A, Tadel F, et al. Mapping the Insula with Stereo-electroencephalography: the emergence of semiology in insula lobe seizures. Ann Neurol, 2020, 88(3): 477-488.
9.	Wang X, Hu W, McGonigal A, et al. Electroclinical features of insulo-opercular epilepsy: an SEEG and PET study. Ann Clin Transl Neurol, 2019, 6(7): 1165-1177.
10.	Proserpio P, Cossu M, Francione S, et al. Insular-opercular seizures manifesting with sleep-related paroxysmal motor behaviors: a stereo-EEG study. Epilepsia, 2011, 52(10): 1781-1791.
11.	Levy A, Yen Tran TP, Boucher O, et al. Operculo-insular epilepsy: scalp and intracranial electroencephalographic findings. J Clin Neurophysiol, 2017, 34(5): 438-447.
12.	Dylgjeri S, Taussig D, Chipaux M, et al. Insular and insulo-opercular epilepsy in childhood: an SEEG study. Seizure, 2014, 23(4): 300-308.
13.	Kerezoudis P, Singh R, Goyal A, et al. Insular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis. J Neurosurg, 2021: 1-13.
14.	Mullatti N, Landre E, Mellerio C, et al. Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures. Epilepsia, 2019, 60(8): 1565-1579.
15.	戴陽, 王逸鶴, 安陽, 等. 立體定向腦電圖引導下立體交叉射頻熱凝毀損治療藥物難治性島葉癲癇的安全性及有效性觀察. 中華醫學雜志, 2021, 101(41): 3386-3392.

1. Ryvlin P, Nguyen DK. Insular seizures and epilepsies: ictal semiology and minimal invasive surgery. Curr Opin Neurol, 2021, 34(2): 153-165.
2. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
3. 中國醫師協會神經外科分會功能神經外科學組, 中國抗癲癇協會, 國家神經外科手術機器人應用示范項目專家指導委員會. 立體定向腦電圖引導射頻熱凝毀損治療藥物難治性癲癇的中國專家共識. 中華醫學雜志, 2021, 101(29): 7.
4. Wieser HG, Blume WT, Fish D, et al. ILAE Commission Report. proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia, 2001, 42(2): 282-286.
5. Isnard J, Guénot M, Sindou M, et al. Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Epilepsia, 2004, 45(9): 1079-1090.
6. Bouthillier A, Weil AG, Martineau L, et al. Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective? J Neurosurg, 2019, 48: 1-10.
7. Wang H, McGonigal A, Zhang K, et al. Semiologic subgroups of insulo-opercular seizures based on connectional architecture atlas. Epilepsia, 2020, 61(5): 984-994.
8. Singh R, Principe A, Tadel F, et al. Mapping the Insula with Stereo-electroencephalography: the emergence of semiology in insula lobe seizures. Ann Neurol, 2020, 88(3): 477-488.
9. Wang X, Hu W, McGonigal A, et al. Electroclinical features of insulo-opercular epilepsy: an SEEG and PET study. Ann Clin Transl Neurol, 2019, 6(7): 1165-1177.
10. Proserpio P, Cossu M, Francione S, et al. Insular-opercular seizures manifesting with sleep-related paroxysmal motor behaviors: a stereo-EEG study. Epilepsia, 2011, 52(10): 1781-1791.
11. Levy A, Yen Tran TP, Boucher O, et al. Operculo-insular epilepsy: scalp and intracranial electroencephalographic findings. J Clin Neurophysiol, 2017, 34(5): 438-447.
12. Dylgjeri S, Taussig D, Chipaux M, et al. Insular and insulo-opercular epilepsy in childhood: an SEEG study. Seizure, 2014, 23(4): 300-308.
13. Kerezoudis P, Singh R, Goyal A, et al. Insular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis. J Neurosurg, 2021: 1-13.
14. Mullatti N, Landre E, Mellerio C, et al. Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures. Epilepsia, 2019, 60(8): 1565-1579.
15. 戴陽, 王逸鶴, 安陽, 等. 立體定向腦電圖引導下立體交叉射頻熱凝毀損治療藥物難治性島葉癲癇的安全性及有效性觀察. 中華醫學雜志, 2021, 101(41): 3386-3392.

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The characteristics of insular epilepsy in children and analysis of the efficacy and safety of radiofrequency thermocoagulation guided by Stereotactic electroencephalogram

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