Dotnet Electrode as a Novel Approach to Explore Epilepsy: Technical Note with Illustrative Cases

Area of Science:

• Neurosurgery
• Epileptology
• Medical Devices

Background:

• Intracranial electroencephalography (iEEG) is crucial for localizing the seizure-onset zone (SOZ) in epilepsy.
• Current iEEG electrode limitations result in partial brain coverage, potentially missing the SOZ and leading to <50% seizure-free rates.
• A novel Dotnet electrode (DNE) was developed for whole-brain data sampling via a minimally invasive keyhole approach.

Purpose of the Study:

• To evaluate the safety and efficacy of the novel Dotnet electrode (DNE) for comprehensive iEEG monitoring.
• To assess the DNE's ability to improve seizure-onset zone (SOZ) localization and surgical outcomes in intractable epilepsy.

Main Methods:

• Described two cases of intractable epilepsy undergoing surgical evaluation with DNE implantation.
• Utilized comprehensive preoperative imaging, surgical notes, and postoperative outcomes for analysis.
• Performed iEEG monitoring with DNEs for seizure-onset zone (SOZ) localization.

Main Results:

• Successfully implanted 27 DNEs (256 contacts) in one patient and 63 DNEs (548 contacts) in another, covering the whole brain.
• Patients tolerated iEEG monitoring (12 and 9 days, respectively) with good signal quality and stability.
• Achieved precise SOZ localization, surgical removal, and complete seizure freedom in both patients with no complications.

Conclusions:

• Dotnet electrodes (DNEs) represent a significant advancement, dramatically increasing iEEG data for precise SOZ localization.
• The minimally invasive DNE technique improves surgical efficacy and patient outcomes in epilepsy.
• Further research is needed to confirm DNE safety, efficacy, and generalizability.