Cortical Stimulation-Induced Seizures Associated With Improved Epilepsy Surgery Outcomes

Inducing seizures during prehospital stays before epilepsy surgery was associated with improved outcomes as published in JAMA. Evaluating data from 103 patients, researchers sought correlations between stimulated seizures and their onset zones, and surgical outcomes. The investigators found that patients in whom seizures were induced had better outcomes than patients did not have induced seizures (P = .02). In both induced and spontaneous seizures, there was a strong similarity between onset zones. 

Seizure induction by cortical stimulation appears to identify the epileptic generator as reliably as spontaneous seizures do; this finding might lead to a more time-efficient intracranial presurgical investigation of focal epilepsy as the need to record spontaneous seizures is reduced.

“I think it would be a huge advantage if this procedure was done in the first days of a patient’s stay,” said Birgit Frauscher, MD, PhD, of the Montreal Neurological Institute and Hospital. “It’s not a new procedure, but the approach is new in the sense that now we know it’s very similar to a spontaneous seizure, so we can reduce hospital time. Instead of being in hospital for 2 weeks, patients can maybe be there for 48 or 72 hours and we only need to record maybe 1 additional spontaneous seizure and not several, and that is a huge difference.” 

In this 2-site study, investigators compared resection of a seizure-onset zone identified with cortical stimulation vs that identified by recording spontaneous seizure. Participants (n = 103) with focal drug-resistant epilepsy underwent stereoEEG before an open surgical procedure, and had follow up of at least 1 year. Of the participants, 59 had cortically-induced seizures to identify seizure onset zones.