INTRODUCTION: Diagnostic cortical stimulation (CS) in intracranial electroencephalography (iEEG) is an established epilepsy presurgical assessment tool to delineate relevant brain functions and elicit habitual epileptic seizures. Currently, no consensus exists as to whether CS should be routinely performed in pediatric patients. A significant challenge is their limited ability to cooperate during the procedure or to describe non-observable seizure semiology features. Our goal was to identify the spectrum of CS practices in Canada, for both eloquent cortex mapping and seizure stimulation. METHODS: An online survey, answered by all 8 Canadian pediatric epilepsy centers, enquired about implantation, stimulation methods, and use of standardized protocols. A systematic literature review extracted detailed stimulation parameters. RESULTS: Most of the institutions (n = 7/8) reported performing CS during presurgical evaluation. Four institutions indicated they perform stimulation in all implanted patients for the purpose of eloquent cortex mapping and seizure stimulation. The majority of physicians had their individual approach to CS. A largely variable approach to CS, mainly in the choice of stimulation parameters (i.e., train and pulse duration), was observed, with the highest variance concerning the purpose of seizure stimulation. The literature review highlighted an overall small sample size and minimal number of publications. Even though there is a rising trend towards stereotactic iEEG implantation, more data were available on subdural EEGs. CONCLUSION: This study shows individual and sparsely validated approach to CS in pediatric epilepsy. The literature review underscores the urgent need to harmonize pediatric intracranial EEG practices. More multicenter studies are needed to identify safe stimulation thresholds and allow implementation of evidence-based guidelines.

McGill University Research Institute of McGill University Health Centre Montreal Canada

Université de Montréal CHU Sainte Justine Montréal Canada

Université de Sherbrooke Centre de neurosciences Sherbrooke Canada

University of Alberta Department of Pediatrics Edmonton Canada

University of British Columbia Pediatric Neurology Vancouver Canada

University of Calgary Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute Calgary Canada

University of Calgary Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute Calgary Canada; Charles University Department of Physiology 2nd Faculty of Medicine Prague Czech Republic

University of Calgary Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute Calgary Canada; Goethe University Epilepsy Center Frankfurt Rhine Main and Department of Neurology Frankfurt am Main Germany

University of Manitoba Max Rady College of Medicine Rady Faculty of Health Sciences Winnipeg Canada

University of Toronto The Hospital for Sick Children Toronto Canada

University of Western Ontario London Health Sciences Centre London Canada

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