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Characterization of low-grade epilepsy-associated tumor from implanted stereoelectroencephalography electrodes.

ABSTRACT: Low-grade epilepsy-associated tumors (LEATs) are a common cause of drug-resistant epilepsy in children. Herein, we demonstrate the feasibility of using tumor tissue derived from stereoelectroencephalography (sEEG) electrodes upon removal to molecularly characterize tumors and aid in diagnosis. An 18-year-old male with focal epilepsy and MRI suggestive of a dysembryoplastic neuroepithelial tumor (DNET) in the left posterior temporal lobe underwent implantation of seven peri-tumoral sEEG electrodes for peri-operative language mapping and demarcation of the peri-tumoral ictal zone prior to DNET resection. Using electrodes that passed through tumor tissue, we show successful isolation of tumor DNA and subsequent analysis using standard methods for tumor classification by DNA, including Glioseq targeted sequencing and DNA methylation array analysis. This study provides preliminary evidence for the feasibility of molecular diagnosis of LEATs or other lesions using a minimally invasive method with microscopic tissue volumes. The implications of sEEG electrodes in tumor characterization are broad but would aid in diagnosis and subsequent targeted therapeutic strategies.

SUBMITTER: Gatesman TA

PROVIDER: S-EPMC10839351 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Characterization of low-grade epilepsy-associated tumor from implanted stereoelectroencephalography electrodes.

Gatesman Taylor A TA Hect Jasmine L JL Phillips H Westley HW Johnson Brenden J BJ Wald Abigail I AI McClung Colleen C Nikiforova Marina N MN Skaugen John M JM Pollack Ian F IF Abel Taylor J TJ Agnihotri Sameer S

Epilepsia open 20231108 1

Low-grade epilepsy-associated tumors (LEATs) are a common cause of drug-resistant epilepsy in children. Herein, we demonstrate the feasibility of using tumor tissue derived from stereoelectroencephalography (sEEG) electrodes upon removal to molecularly characterize tumors and aid in diagnosis. An 18-year-old male with focal epilepsy and MRI suggestive of a dysembryoplastic neuroepithelial tumor (DNET) in the left posterior temporal lobe underwent implantation of seven peri-tumoral sEEG electrode ...[more]

PMID: 37798921

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Project description:ObjectiveThis study aimed to evaluate the surgical outcomes and relevant prognostic factors in patients with low-grade epilepsy-associated neuroepithelial tumors (LEAT) and, especially, to develop a scoring system to predict postoperative seizure outcomes.MethodsThe clinical data of patients who underwent epilepsy surgery for LEAT were retrospectively studied. The surgical outcomes of seizure and neurological statuses in patients were evaluated using Engel classification and modified Rankin Scale (mRS) scoring, respectively. A scoring system of seizure outcomes was constructed based on the weight of the β-coefficient estimate of each predictor in the final multivariate predicting model of seizure outcomes.ResultsOf the 287 patients (106 female) enrolled, the median age was 19 years at surgery and 10 years at seizure onset, with a median duration of epilepsy of 60 months. Among 258 patients who were followed up for at least 12 months, 215 (83.3%) patients had a favorable seizure outcome (Engel class I) after surgery, and 43 (16.7%) patients had an unfavorable seizure outcome; longer duration of epilepsy, discordant magnetoencephalography (MEG) findings, and acute postoperative seizures were significantly included in the scoring system to predict unfavorable seizure outcomes, and in the scoring system, accumulated scoring of 0-19 scores was recorded, which were finally grouped into three risk levels: low risk (risk < 30%), medium risk (30% ≤ risk < 70%), and high risk (risk ≥ 70%). In addition, favorable neurological outcomes (mRS score 0-1) were recorded in 187 (72.5%) patients, while unfavorable neurological outcomes were recorded in 71 (27.5%) patients, which were significantly related to poor seizure control, older age at surgery, and longer duration of epilepsy and hospitalization time.SignificanceThe long-term surgical outcomes of LEAT after surgery were satisfactory. A scoring system for predicting unfavorable seizure outcomes with different risk levels was developed, which could partly guide clinical treatments of LEAT.

Project description:BackgroundStereoelectroencephalography (SEEG) has become a common diagnostic method in epilepsy surgery and is found to be safe for a wide range of clinical applications. SEEG combined with radiofrequency thermocoagulation (RF-TC) not only reveals the seizure onset zone by hypothesis, but also acts as a treatment option without any additional cost to institutions and patients. Thus, we analyzed the treatment of the SEEG-guided RF-TC.MethodsThis retrospective study analyzed seventeen epileptic patients treated with RF-TC between April 2019 and December 2020. All patients underwent a single round of SEEG-guided RF-TC treatment after more than three habitual seizures were recorded. The demographic characteristics of the patients were retrospectively reviewed. Outcomes were assessed using the Engel classification system.ResultsAll patients underwent SEEG-guided RF-TC without catastrophic functional damage. Follow-up data of all patients were complete. The number of contacts per patients where RF-TC was applied ranged from 9 to 43 (mean: 17.7±10.2). After RF-TC, the types of anti-epileptic drugs used reduced from 2.4±0.7 to 1.6±0.7. With RF-TC alone, four (23.5%) patients achieved Engel Ia, two (11.8%) patients achieved Engel Ib, one patient underwent resection without seizure at the 5-month follow-up, five patients had a relapse after 3-10 months of seizure freedom, and five patients had recurrence after 1 month. After RF-TC, six patients underwent secondary interventions followed by resection. Overall, 12 patients achieved Engel Ia or Ib, three patients achieved Engel IIa or IIb, and two patients achieved Engel IIIa. There were no Engel IV cases.ConclusionsSEEG-guided RF-TC performed in our institution was found to be a safe ablation procedure for the treatment of drug-resistant focal epilepsy. All patients experienced a reduction in the frequency of seizures after receiving RF-TC. RF-TC can be used as a palliative treatment option for patients with epilepsy who refuse surgery or cannot undergo resection surgery. Recurrence of focal epilepsy after RF-TC can be treated with resection surgery to achieve the seizure-free status.

Dataset Information

Characterization of low-grade epilepsy-associated tumor from implanted stereoelectroencephalography electrodes.

Publications

Characterization of low-grade epilepsy-associated tumor from implanted stereoelectroencephalography electrodes.

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