Pediatric considerations in methodology of electrical brain stimulation during SEEG

Electrical stimulation (ES) during stereoelectroencephalography (SEEG) plays a key role in functional mapping in drug-resistant epilepsy. In pediatrics, protocols must account for neurodevelopmental stage. Moreover, pediatric data remain scarce and protocols vary substantially across centers. Such heterogeneity limits comparability between studies and hinders the evaluation of stimulation efficacy and its prognostic value for postoperative functional deficits. This work aims to provide expert consensus to harmonize SEEG stimulation protocols in the pediatric population.

A multidisciplinary task force of French experts from French pediatric epilepsy surgery centers reviewed existing guidelines and integrated current knowledge from developmental neurosciences. Through consensus, pediatric-specific parameters and practices were defined.

The task force establishes practical guidance for stimulation frequency, intensity, and duration adapted to children, with emphasis on safety, feasibility, and neurodevelopmental context. Suggested protocols are designed to optimize both epileptogenic zone (EZ) delineation and functional mapping while enabling multicenter comparability.

The proposed methods provide a framework for safe and effective pediatric SEEG stimulation. They aim to standardize clinical practice, improve presurgical evaluations, and support collaborative research in pediatric epilepsy surgery.