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Updated: Jun 26, 2026

Investigating the Function of Deep Cortical and Subcortical Structures Using Stereotactic Electroencephalography: Lessons from the Anterior Cingulate Cortex
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Extraoperative Subdural Grid Electrode Stimulation for Primary Motor Cortex Localization in Medically Intractable

Panu Boontoterm1, Siraruj Sakoolnamarka1, Karanarak Urasyanandana1

  • 1Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand.

Journal of Epilepsy Research
|June 25, 2026
PubMed
Summary
This summary is machine-generated.

Extraoperative cortical stimulation mapping accurately locates the primary motor cortex in epilepsy patients. Younger children require higher stimulation amplitudes, highlighting the need for direct functional mapping.

Keywords:
ElectrodesEpilepsyImplantedMappingNeurosurgeryPrimary motor cortex

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neurophysiology

Background:

  • Subdural grid electrode (SDE) implantation with cortical stimulation mapping (CSM) is crucial for presurgical evaluation in intractable epilepsy.
  • Accurate identification of the primary motor cortex (PMC) is vital to prevent motor deficits, especially in pediatric cases.

Purpose of the Study:

  • To assess the clinical utility of extraoperative CSM for PMC localization.
  • To investigate factors influencing stimulation amplitude thresholds for PMC mapping.

Main Methods:

  • Retrospective review of 297 patients with medically refractory epilepsy undergoing SDE implantation and extraoperative CSM.
  • Standardized motor mapping, assessment of postoperative motor outcomes, and correlation with PMC preservation.
  • Analysis of associations between stimulation amplitude thresholds and various patient/treatment factors.

Main Results:

  • Successful PMC identification in all patients; atypical localization occurred in 11.1%.
  • Preservation of mapped PMC correlated with reduced persistent motor deficits.
  • Younger age (<7 years) showed an inverse correlation with stimulation amplitude thresholds, even after controlling for antiseizure medication (ASM) burden.

Conclusions:

  • Extraoperative CSM with SDEs is a reliable method for PMC localization in epilepsy.
  • Functional motor areas can deviate from anatomical landmarks, emphasizing the importance of direct functional mapping.