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Mapping white matter tracts with SEEG electrodes.

Davide Giampiccolo1,2,3, Jan van Dijk1,4, Alejandro Granados5

  • 1Department of Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK.

Epilepsia
|November 26, 2025
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Summary

Stereo-electroencephalography (SEEG) electrodes frequently sample white matter (WM) tracts, particularly association fibers. This study validates SEEG-WM stimulation for precise pathway targeting in epilepsy patients.

Keywords:
SEEGepilepsyepilepsy surgerywhite matter anatomy

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Epileptology

Background:

  • Stereo-electroencephalography (SEEG) primarily targets gray matter (GM) for epilepsy localization.
  • SEEG electrodes traverse white matter (WM) tracts crucial for neural networks and cognition.
  • Understanding WM tract sampling by SEEG is vital for exploring novel stimulation techniques.

Purpose of the Study:

  • To retrospectively evaluate WM tract sampling by SEEG electrodes in epilepsy patients.
  • To identify WM pathways suitable for prospective WM stimulation studies.
  • To validate SEEG-guided WM stimulation.

Main Methods:

  • Retrospective analysis of 86 patients undergoing SEEG implantation for drug-resistant epilepsy.
  • Postoperative CT and MRI co-registration for precise electrode contact localization.
  • Probabilistic WM atlases and preoperative tractography for assessing WM tract involvement.
  • Image-guided SEEG stimulation of WM pathways.

Main Results:

  • Over 75% of intraparenchymal SEEG contacts sampled WM pathways, averaging 21 tracts per patient.
  • Commissural fibers (corpus callosum) and association fibers (IFOF, SLF II, cingulum) were near-universally sampled.
  • WM stimulation in two patients induced reproducible, tract-selective phosphenes at low current levels.

Conclusions:

  • SEEG electrodes extensively sample WM structures, with association pathways being highly accessible.
  • These findings support systematic WM stimulation protocols using SEEG.
  • SEEG-WM stimulation, guided by preoperative tractography, is a validated approach for precise neural pathway targeting.