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French guidelines on stereoelectroencephalography (SEEG).

Jean Isnard1, Delphine Taussig2, Fabrice Bartolomei3

  • 1Department of Functional Neurology and Epileptology, Hospital for Neurology and Neurosurgery Pierre-Wertheimer, hospices Civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm U1028, CNRS 5292, TIGER: Neuroscience research center of Lyon, 69675 Bron cedex, France.

Neurophysiologie Clinique = Clinical Neurophysiology
|December 27, 2017
PubMed
Summary

Stereoelectroencephalography (SEEG) provides precise 3D mapping for drug-resistant epilepsy, aiding diagnosis and treatment like thermocoagulation. This French expert consensus offers guidelines for SEEG best practices, especially for new centers.

Keywords:
AdultsChildrenDrug-resistant epilepsyEpilepsy surgeryFocal epilepsyGuidelinesInvasive explorationStereo-electroencephalogramThermocoagulations

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Clinical Neurophysiology

Background:

  • Stereoelectroencephalography (SEEG) is an invasive technique developed in the 1960s for drug-resistant focal epilepsies.
  • It offers precise 3D spatio-temporal analysis of epileptic discharges, enabling anatomo-electrical correlations and tailored surgical interventions.
  • While historically limited to European centers, SEEG use has globally expanded, now including therapeutic applications like thermocoagulation.

Purpose of the Study:

  • To establish formal guidelines for best clinical practices in SEEG.
  • To present a consensual French approach to SEEG, serving as a foundational document for centers, particularly those new to the practice.
  • To consolidate expert experience and literature-based recommendations for SEEG indications, planning, technique, interpretation, and thermocoagulation.

Main Methods:

  • Formation of a working party comprising French experts with extensive SEEG experience (performing >10 SEEG/year for >5 years).
  • Grading of recommendations by all participants using established methodology.
  • Summarization of recommendations covering indications, limits, planning, management, surgical technique, electrophysiological procedures, interpretation, and SEEG-guided thermocoagulation.

Main Results:

  • The article summarizes SEEG best practice recommendations based on expert consensus and literature review.
  • Detailed discussions by expert subgroups cover all aspects of SEEG, from initial planning to therapeutic interventions.
  • The guidelines address indications, limitations, surgical and electrophysiological techniques, interpretation, and SEEG-guided radiofrequency thermocoagulation.

Conclusions:

  • The developed guidelines represent a consensual French approach to SEEG.
  • This document aims to support centers in their SEEG practice, especially those initiating the procedure.
  • The guidelines are endorsed by the French Clinical Neurophysiology Society and the French chapter of the International League Against Epilepsy.