• Agnes Trebuchon, Renata Racila, Francesco Cardinale, Stanislas Lagarde, Aileen McGonigal, Lo RussoGiorgioGEpilepsy and Parkinson Surgery Centre "C. Munari", Ospedale Niguarda Ca' Granda, Milan, Italy., Didier Scavarda, Romain Carron, Roberto Mai, Patrick Chauvel, Fabrice Bartolomei, and Stefano Francione.
• Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France agnes.trebuchon@univ-amu.fr.
• J. Neurol. Neurosurg. Psychiatr. 2020 Oct 28.

ObjectiveDirect electrical stimulations of cerebral cortex are a traditional part of stereoelectroencephalography (SEEG) practice, but their value as a predictive factor for seizure outcome has never been carefully investigated.Patients And MethodWe retrospectively analysed a cohort of 346 patients operated on for drug-resistant focal epilepsy after SEEG exploration. As potential predictors we included: aetiology, MRI data, age of onset, duration of epilepsy, age at surgery, topography of surgery and whether a seizure was induced by either low frequency electrical stimulation (LFS) or high frequency electrical stimulation.ResultsOf 346 patients, 63.6% had good outcome (no seizure recurrence, Engel I). Univariate analysis demonstrated significant correlation with favourable outcome (Engel I) for: aetiology, positive MRI and seizure induced by stimulation. At multivariate analysis, informative MRI, type II focal cortical dysplasia and tumour reduced the risk of seizure recurrence (SR) by 47%, 58% and 81%, respectively. Compared with the absence of induced seizures, the occurrence of ictal events after LFS significantly predicts a favourable outcome on seizures, with only 44% chance of disabling SR at last follow-up.ConclusionAmong the already known predictors outcome, seizure induction by LFS therefore represents a positive predictive factor for seizure outcome after surgery.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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