Successful stereoelectroencephalography re-evaluation in epilepsy patients after failed initial subdural grid
Stuti Joshi1, Eleanor Stephens1, Andrew Bleasel1,2
1Department of Neurology and Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia.
Summary
Stereoelectroencephalography (SEEG) can improve epilepsy surgery outcomes. In patients with prior surgical failure after subdural grid evaluation (SDE), SEEG re-evaluation led to seizure freedom in two-thirds of cases.
Area of Science:
- Neurosurgery
- Epileptology
- Neurology
Background:
- Accurate localization of the epileptogenic zone is crucial for successful epilepsy surgery.
- Invasive electroencephalography (EEG) using subdural grid electrodes (SDE) is a common method for localization.
- Despite SDE, some patients experience surgical failure due to persistent seizures.
Purpose of the Study:
- To evaluate the utility of stereoelectroencephalography (SEEG) as a second-line diagnostic tool.
- To assess SEEG's effectiveness in patients with prior unsuccessful SDE for seizure localization.
Main Methods:
- Retrospective review of patients who underwent SDE.
- Identification of patients who subsequently underwent SEEG re-evaluation.
- Analysis of seizure outcomes following re-operation guided by SEEG.
Main Results:
- Three patients with prior SDE failure underwent SEEG in the epileptogenic zone region.
- Two of these three patients became seizure-free after a second resection guided by SEEG.
- SEEG provided valuable information for re-operation in cases of initial SDE failure.
Conclusions:
- Stereoelectroencephalography can be a valuable tool for re-evaluating patients with epilepsy.
- SEEG can aid in successful re-operation for patients who did not achieve seizure freedom with initial SDE.
- This approach may improve surgical outcomes in refractory epilepsy cases.
