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Stereo-EEG ictal/interictal patterns and underlying pathologies.

Roberta Di Giacomo1, Reinaldo Uribe-San-Martin2, Roberto Mai3

  • 1Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; Claudio MunariEpilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.

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Summary
This summary is machine-generated.

Specific Stereo-EEG (SEEG) patterns correlate with distinct pathologies in drug-resistant focal epilepsy. Identifying these neurophysiological patterns improves seizure control in patients with conditions like focal cortical dysplasia.

Keywords:
Epilepsy surgeryEpileptogenic zoneInterictal activityMalformations of cortical developmentSeizure onset zoneStereo-EEG

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Area of Science:

  • Neuroscience
  • Epileptology
  • Clinical Neurophysiology

Background:

  • Drug-resistant focal epilepsy presents diagnostic challenges.
  • Stereo-EEG (SEEG) is crucial for localizing seizure onset zones.
  • Understanding pathology-specific SEEG patterns aids treatment planning.

Purpose of the Study:

  • To define Stereo-EEG (SEEG) ictal and interictal patterns in drug-resistant focal epilepsy.
  • To associate these patterns with specific pathologies including Polymicrogyria (PMG), Periventricular Nodular Heterotopia (PNH), Focal Cortical Dysplasia (FCD) types I, IIa, IIb, and Hippocampal Sclerosis (HS).
  • To correlate neurophysiological findings with histopathological diagnoses.

Main Methods:

  • Retrospective analysis of SEEG recordings from 102 epilepsy patients.
  • Review of ictal and interictal SEEG data to identify Seizure Onset Zone (SOZ) patterns.
  • Correlation of SEEG patterns with confirmed pathologies (PMG, PNH, FCD, HS).

Main Results:

  • Five distinct SEEG-SOZ patterns were identified.
  • Specific associations found: low-voltage fast activity with PMG; repetitive fast spikes with FCD IIa.
  • Seizure freedom achieved in 58% of surgically treated and 72% of thermocoagulated patients.
  • 84% seizure freedom in patients with PMG, FCD I, IIa, IIb showing characteristic SEEG patterns.

Conclusions:

  • Specific histopathologies in focal epilepsies correlate with distinct neurophysiological SEEG patterns.
  • These lesion-specific seizure patterns aid in guiding surgical or ablative treatments.
  • Interictal activity alone is insufficient for precise SEEG-SOZ delineation, except for FCD type II.