Can the 5-SENSE score guide stereo-electroencephalography in children? First validation in a purely pediatric cohort

OBJECTIVE: Stereo-electroencephalography (SEEG) is increasingly being used in pediatric epilepsy surgery to delineate the epileptogenic zone (EZ) and its relationship to functional cortex, ultimately guiding resection. However, accurately identifying which children with presumed focal epilepsy will benefit from electrode implantation remains challenging, particularly in MRI-negative cases. The 5-SENSE score, developed and validated primarily in adults, integrates 5 noninvasive clinical variables to estimate the likelihood of identifying an EZ using SEEG. This study presents the first validation of the 5-SENSE score in a purely pediatric population. METHODS: The authors conducted a retrospective analysis of electroclinical and imaging data of patients younger than 19 years seen at a tertiary pediatric epilepsy surgery center who underwent SEEG. Data were extracted from presurgical evaluations, and the 5-SENSE score was calculated for each patient based on 1) the presence of a focal lesion on MRI, 2) regional ictal onset on scalp video-EEG, 3) absence of bilateral independent interictal discharges, 4) localizing clinical semiology, and 5) neuropsychology. SEEG outcomes were reviewed to determine whether a focal EZ was identified and compared with 5-SENSE predictions. RESULTS: Seventy-nine patients (median age 13 years, range 3-18 years) with full information were included. The 5-SENSE score demonstrated a sensitivity of 70.7% (95% CI 58.3%-81.3%) and a specificity of 71.4% (95% CI 50.4%-87.5%) for identifying a focal EZ. The area under the receiver operating characteristic curve was 0.72 (95% CI 0.57-0.86), indicating that the 5-SENSE score accurately predicted favorable SEEG outcomes. The positive and negative predictive values were 87.2% and 46.9%, respectively. These findings are consistent with those of adult validation studies. CONCLUSIONS: This is the first validation of the 5-SENSE score in a purely pediatric population. While it shows moderate predictive accuracy, a low score does not exclude the possibility that SEEG might still identify a focal area of seizure onset.