Seizure outcomes of sEEG-guided surgery for temporal vs. extratemporal epilepsy in children

Abstract Rationale This study aimed to compare seizure outcomes in pediatric patients with drug-resistant epilepsy (DRE) between temporal lobe (TLE) and extratemporal epilepsy (ETLE) following stereo-electroencephalography (sEEG) to inform surgical decision making. Methods A retrospective chart review was conducted for pediatric patients with DRE who underwent sEEG monitoring at University of Pittsburgh Medical Center (UPMC) Children's Hospital from January 2019 to November 2025, characterized according to TLE vs ETLE. Data collected included demographics, age at seizure onset, baseline seizure frequency, MRI findings, and number of antiseizure medications, analyzed via Chi-square tests, Fisher's exact and Wilcoxon rank sum test. Results Sixty-six patients (57 % male) underwent sEEG monitoring, 32 (48 %) of which were DRE with temporal lobe involvement. Invasive monitoring was followed by subsequent neurosurgical intervention in 64 (97 %) cases. Primary outcomes including seizure freedom at one year following the most recent surgical intervention. There was no significant difference in one year seizure freedom rate between patients with TLE (59 %) and ETLE (56 %) (p = 0.77). The number of sEEG electrode trajectories was significantly associated with one-year seizure freedom in a non-linear fashion (p = 0.005), with higher trajectory counts associated with lower probability of seizure freedom. Conclusions In contrast to adult-focused literature, this pediatric cohort demonstrated no significant differences between temporal lobe and extratemporal lobe sEEG-guided surgical outcomes. The number of sEEG electrode trajectories emerged as a significant predictor of seizure freedom, suggesting that the complexity of epileptogenic zone, rather than its anatomical location, may be the primary determinant of surgical outcome in children.