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False lateralization by subdural electrodes in two patients with temporal lobe epilepsy
T M Alsaadi1, K D Laxer, N M Barbaro
1Department of Neurology, University of California, San Francisco, CA, USA. taoufik.alsaadi@uucdmc.ucdavis.edu
Neurology
|August 15, 2001
Summary
Stereotactic depth EEG (SEEG) is crucial for epilepsy surgery. Subdural electrodes can mislead in temporal lobe epilepsy cases with mesial temporal sclerosis, necessitating SEEG when presurgical findings conflict.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Presurgical evaluation for epilepsy surgery aims to precisely localize the seizure onset zone.
- Invasive monitoring using stereotactic depth EEG (SEEG) and subdural electrodes (SDE) is employed when non-invasive methods are inconclusive.
Observation:
- Two patients with medically refractory partial seizures underwent invasive monitoring with both SEEG and SDE.
- Both patients had pathologically confirmed mesial temporal sclerosis.
Findings:
- Subdural electrode (SDE) recordings provided false lateralization in both cases.
- Stereotactic depth EEG (SEEG) is essential for accurate localization in complex epilepsy cases.
Implications:
- The findings highlight the limitations of SDE in specific epilepsy subtypes.
- SEEG should be strongly considered in the presurgical workup of temporal lobe epilepsy, particularly when SDE results are discordant with other investigations.