title: Stereoelectroencephalography in children and adolescents with difficult-to-localize refractory focal epilepsy.
abstract: BACKGROUND
  Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision making in focal epilepsy, there are few reports addressing the utility and safety of SEEG methodology applied to children and adolescents.
  
  
  OBJECTIVE
  To present the results of our early experience using SEEG in pediatric patients with difficult-to-localize epilepsy who were not considered candidates for subdural grid evaluation.
  
  
  METHODS
  Thirty children and adolescents with the diagnosis of medically refractory focal epilepsy (not considered ideal candidates for subdural grids and strip placement) underwent SEEG implantation. Demographics, electrophysiological localization of the hypothetical epileptogenic zone, complications, and seizure outcome after resections were analyzed.
  
  
  RESULTS
  Eighteen patients (60%) underwent resections after SEEG implantations. In patients who did not undergo resections (12 patients), reasons included failure to localize the epileptogenic zone (4 patients); multifocal epileptogenic zone (4 patients); epileptogenic zone located in eloquent cortex, preventing resection (3 patients); and improvement in seizures after the implantation (1 patient). In patients who subsequently underwent resections, 10 patients (55.5%) were seizure free (Engel class I) and 5 patients (27.7%) experienced seizure improvement (Engel class II or III) at the end of the follow-up period (mean, 25.9 months; range, 12 to 47 months). The complication rate in SEEG implantations was 3%.
  
  
  CONCLUSIONS
  The SEEG methodology is safe and should be considered in children/adolescents with difficult-to-localize epilepsy. When applied to highly complex and difficult-to-localize pediatric patients, SEEG may provide an additional opportunity for seizure freedom in association with a low morbidity rate.
authors.affiliation: *Department of Neurosurgery and ‡Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez-Martinez
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mullin
authors.forename: Juan
authors.initials: J
authors.lastname: Bulacio
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.forename: Rei
authors.initials: R
authors.lastname: Enatsu
authors.forename: Imad
authors.initials: I
authors.lastname: Najm
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.forename: Elaine
authors.initials: E
authors.lastname: Wyllie
authors.forename: Deepak
authors.initials: D
authors.lastname: Lachhwani
mesh_terms: D000293:Adolescent; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003199:Computer Systems; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D055815:Young Adult