Should spikes on post-resection ECoG guide pediatric epilepsy surgery?

Hansel M. Greiner, Paul S. Horn, Jeffrey R. Tenney, Ravindra Arya, Sejal V. Jain, Katherine D. Holland, James L. Leach, Lili Miles, Douglas F. Rose, Hisako Fujiwara, Francesco T. Mangano

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: There is wide variation in clinical practice regarding the role of electrocorticography immediately after resection (post-resection ECoG) for pediatric epilepsy surgery. Results can guide further resection of potentially epileptogenic tissue. We hypothesized that post-resection ECoG spiking represents a biomarker of the epileptogenic zone and predicts seizure outcome in children undergoing epilepsy surgery. Methods: We retrospectively identified 124 children with post-resection ECoG performed on the margins of resection. ECoG records were scored in a blinded fashion based on presence of frequent spiking. For patients identified as having additional resection based on clinical post-resection ECoG interpretation, these "second-look" ECoG results were re-reviewed for ongoing discharges or completeness of resection. Frequent spike populations were grouped using a standard scoring system into three ranges: 0.1-0.5 Hz, 0.5-1 Hz, >1 Hz. Seizure outcomes were determined at minimum 12-month followup. Results: Of 124 patients who met inclusion criteria, 60 (48%) had an identified spike population on post-resection ECoG. Thirty (50%) of these had further resection based on clinical interpretation. Overall, good outcome (ILAE 1) was seen in 56/124 (45%). Completeness of resection of spiking (absence of spiking on initial post-resection ECoG or resolution of spiking after further resection) showed a trend toward good outcome (OR 2.03, p = 0.099). Patients with completeness of resection had good outcome in 41/80 (51%) of cases; patients with continued spikes had good outcome in 15/44 (35%) of cases. Conclusions: Post-resection ECoG identifies residual epileptogenic tissue in a significant number of children. Lower frequency or absence of discharges on initial recording showed a trend toward good outcome. Completeness of resection demonstrated on final ECoG recording did not show a significant difference in outcome. This suggests that post-resection discharges represent a prognostic marker rather than a remediable biomarker of the epileptogenic zone in all patients. Resecting residual spike-generating cortex may be beneficial in selected patients, including children with tumors.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalEpilepsy Research
StatePublished - May 1 2016
Externally publishedYes


  • Epilepsy surgery
  • Invasive EEG
  • Pediatric epilepsy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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