Extending high-frequency oscillation analysis to pediatric electrocorticography

Pediatric epilepsy surgery often can be performed successfully without invasive monitoring to define the epileptic zone. For example, candidates for certain procedures like hemispherectomy or corpus callosotomy usually do not require investigations with invasive electrodes or intraoperative electrocorticography (ECoG); similarly, children with mesial temporal sclerosis may not need invasive monitoring, particularly if there is no sign of cortical dysplasia.¹

Children with other forms of focal lesions present different challenges. Pediatric surgical series show that the most common pathology is focal cortical dysplasia² and the exact extent of the lesion is not always apparent on imaging. Some centers, including our own, prefer single-stage resections with ECoG guidance to prolonged recordings using intracranial electrodes, particularly in those patients with congruent noninvasive findings implicating a discrete focus. The seizure focus can be noninvasively localized from multiple sources including ictal EEG, interictal EEG, seizure semiology, MRI, SPECT, PET, and magnetoencephalography. …