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Comparing electrical stimulation functional mapping with subdural electrodes and stereoelectroencephalography.

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Stereoelectroencephalography (SEEG) electrical stimulation mapping (ESM) shows comparable language and motor localization to subdural electrodes (SDE) but offers better sensory mapping and safety. SEEG ESM has fewer afterdischarges and seizures than SDE ESM.

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Epileptology

Background:

  • Electrical stimulation mapping (ESM) using subdural electrodes (SDE) is the standard for functional brain localization.
  • Stereoelectroencephalography (SEEG) is an emerging alternative for intracranial electrode placement.
  • Direct comparison of functional responses, afterdischarges (ADs), and ESM-induced seizures (EISs) between SDE and SEEG is crucial for clinical practice.

Purpose of the Study:

  • To compare functional responses, ADs, and EISs between SEEG and SDE during ESM.
  • To investigate the influence of age, electrode type, and other factors on stimulation thresholds.
  • To assess the safety and neurophysiological validity of SEEG ESM versus SDE ESM.

Main Methods:

  • Retrospective analysis of 67 SEEG ESM and 106 SDE ESM patients.
  • Comparison of incidence and current thresholds for sensory, motor, and language responses, ADs, and EISs.
  • Mixed models were used to analyze data, controlling for covariates like age and stimulation parameters.

Main Results:

  • Similar incidence of language and motor responses between SEEG and SDE; SEEG showed more sensory responses.
  • Lower incidence of ADs and EISs observed with SEEG compared to SDE.
  • Age significantly decreased thresholds for responses and EISs; AD thresholds were higher with SEEG. Functional thresholds remained below AD thresholds for longer in SEEG patients.

Conclusions:

  • SEEG and SDE demonstrate clinically relevant differences in functional brain mapping.
  • SEEG offers potentially superior safety and neurophysiological validity due to lower AD/EIS rates and a more favorable functional-to-AD threshold relationship.
  • SEEG provides enhanced likelihood of identifying sensory areas compared to SDE.