[Stereoelectroencephalography - a safe and effective procedure for epilepsy surgery evaluation]

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurophysiology

Background:

• Drug-resistant epilepsy poses significant challenges for patient management.
• Accurate localization of seizure onset zones is crucial for successful surgical intervention.
• Stereoelectroencephalography (SEEG) offers detailed insights into brain activity for epilepsy surgery planning.

Purpose of the Study:

• To evaluate the safety and efficacy of stereoelectroencephalography (SEEG) in patients with drug-resistant epilepsy.
• To assess the outcomes of resective epilepsy surgery guided by SEEG findings.
• To report initial experiences with SEEG at Sahlgrenska University Hospital.

Main Methods:

• Retrospective review of clinical, neurophysiological, and imaging data from 30 patients (12 children, 18 adults) with drug-resistant epilepsy.
• 33 SEEG procedures were performed, with a median of 12 electrodes implanted per patient.
• Analysis of resective surgery outcomes and complication rates.

Main Results:

• 53% of patients had normal brain MRI findings, highlighting the need for advanced localization techniques.
• Focal cortical dysplasia was identified in all patients undergoing resective surgery.
• Epilepsy surgery guided by SEEG resulted in seizure freedom in 58% of cases.
• Minor complications occurred in 8 patients, with no major adverse events reported.

Conclusions:

• Stereoelectroencephalography (SEEG) is a safe and effective diagnostic tool for delineating seizure generation areas in drug-resistant epilepsy.
• SEEG-guided resective surgery can lead to significant seizure reduction and freedom in a substantial proportion of patients.
• The findings support the utility of SEEG in complex epilepsy cases, including those with normal MRI or eloquent cortex involvement.