Old Lesions and New Targets: sEEG-Identified Onsets in Traditionally Inoperable Epilepsy Lesions and Associated
Yosef M Dastagirzada1, Spencer Frome2, Daniel J Curry3,4
1Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA, yosef.dastagirzada@nyulangone.org.
Background:
Patients with epilepsy who do not respond to pharmacotherapy are often offered a noninvasive diagnostic workup to localize an epileptogenic focus that might be treated with resection, neuromodulation, or ablation. Yet in many cases, this evaluation fails to identify surgical candidates.
Summary:
Patients with tuberous sclerosis, periventricular nodular heterotopia, or polymicrogyria may have clearly visible lesions on MRI, but the resulting epileptogenic onset zones/networks are often too complex for scalp electroencephalography to decode. Similarly, seizures arising from the cingulate gyrus originate in deep structures that are inaccessible to noninvasive techniques. In post-traumatic epilepsy without a dominant lesion such as mesial temporal sclerosis, injury is often too diffuse to define a clear seizure-onset zone. Stereoelectroencephalography (sEEG), with its ability to map deep brain networks in detail, offers a unique solution for these challenging cases.
Key Messages:
In this review, we highlight how sEEG has expanded surgical options and provided hope for seizure freedom in patients once considered medically and surgically untreatable, and we aim to encourage further study into its potential applications.
Insights
Stereoelectroencephalography (sEEG) helps identify epilepsy surgery candidates when standard methods fail. This advanced technique maps deep brain networks, offering hope for seizure freedom in complex cases.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Pharmacotherapy-resistant epilepsy often requires surgical intervention.
- Noninvasive diagnostics frequently fail to pinpoint the epileptogenic zone in complex cases.
- Conditions like tuberous sclerosis, heterotopia, polymicrogyria, cingulate gyrus seizures, and diffuse post-traumatic injury pose diagnostic challenges.
Purpose of the Study:
- To review the utility of stereoelectroencephalography (sEEG) in diagnosing difficult epilepsy cases.
- To highlight how sEEG expands surgical options for previously untreatable patients.
- To encourage further research into sEEG applications for epilepsy management.
Main Methods:
- Review of literature on stereoelectroencephalography (sEEG) in epilepsy.
- Analysis of sEEG's ability to map deep brain networks.
- Case examples illustrating sEEG's role in identifying surgical candidates.
Main Results:
- sEEG provides detailed mapping of deep brain networks, crucial for localizing seizure onset.
- It identifies surgical candidates in cases where MRI and scalp EEG are insufficient.
- sEEG has expanded treatment options for patients with complex lesional and non-lesional epilepsy.
Conclusions:
- Stereoelectroencephalography (sEEG) is a valuable tool for complex epilepsy diagnosis.
- It enables surgical treatment for patients previously deemed untreatable.
- Further investigation into sEEG's potential is warranted to improve epilepsy outcomes.
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