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Updated: Jul 29, 2026
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Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
FIRDA, refractory epilepsy, and SEEG-guided RF: A case report
Nir Getter1,2,3, Jehuda Sepkuty1,4, Maya Weinstein1,5
1Assuta Medical Center, Functional Neurosurgerie Group, Tel Aviv, Israel.
Epilepsia Open
|May 9, 2022
Summary
Frontal intermittent rhythmic delta activity (FIRDA) can serve as an epileptic biomarker for deep-seated seizures. Its reduction after SEEG-guided radiofrequency ablation correlates with improved clinical outcomes, indicating its utility for inaccessible seizure origins.
Area of Science:
- Neuroscience
- Epileptology
- Clinical Neurophysiology
Background:
- Frontal intermittent rhythmic delta activity (FIRDA) is typically associated with systemic disorders and encephalopathy.
- Its potential role as an epileptic biomarker, particularly for deep-seated seizure onset zones (SOZ), remains underexplored.
Observation:
- A case report details a patient with psychiatric and gastrointestinal complaints, alongside FIRDA during VEEG.
- The patient exhibited refractoriness to antiepileptic drugs (AEDs) and MRI findings suggestive of left temporo-mesial SOZ.
Findings:
- Stereoelectroencephalography (SEEG) revealed a correlation between left hippocampal spikes and high-frequency oscillations (HFOs) with FIRDA on scalp EEG, coinciding with behavioral changes.
- Radiofrequency (RF) ablation of the identified SOZ successfully eliminated epileptiform activity, including FIRDA, leading to clinical improvement.
Implications:
- This study highlights FIRDA as a significant noninvasive biomarker for latent, refractory mesial epilepsy.
- SEEG can identify deep SOZs manifesting as FIRDA on scalp EEG, which can be targeted for therapeutic intervention like RF ablation.
