<p>Stereoelectroencephalography in epilepsy, cognitive neurophysiology, and psychiatric disease: safety, efficacy, and place in therapy</p>

Abstract

For patients with drug-resistant epilepsy, surgical intervention may be an effective treatment option if the epileptogenic zone (EZ) can be well localized. Subdural strip and grid electrode (SDE) implantations have long been used as the mainstay of intracranial seizure localization in the United States. Stereoelectroencephalography (SEEG) is an alternative approach in which depth electrodes are placed through percutaneous drill holes to stereotactically defined coordinates in the brain. Long used in certain centers in Europe, SEEG is gaining wider popularity in North America, bolstered by the advent of stereotactic robotic assistance and mounting evidence of safety, without the need for catheter-based angiography. Rates of clinically significant hemorrhage, infection, and other complications appear lower with SEEG than with SDE implants. SEEG also avoids unnecessary craniotomies when seizures are localized to unresectable eloquent cortex, found to be multifocal or nonfocal, or ultimately treated with stereotactic procedures such as laser interstitial thermal therapy (LITT), radiofrequency thermocoagulation (RF-TC), responsive neurostimulation (RNS), or deep brain stimulation (DBS). While SDE allows for excellent localization and functional mapping on the cortical surface, SEEG offers a less invasive option for sampling disparate brain areas, bilateral investigations, and deep or medial targets. SEEG has shown efficacy for seizure localization in the temporal lobe, the insula, lesional and nonlesional extra-temporal epilepsy, hypothalamic hamartomas, periventricular nodular heterotopias, and patients who have had prior craniotomies for resections or grids. SEEG offers a valuable opportunity for cognitive neurophysiology research and may have an important role in the study of dysfunctional networks in psychiatric disease and understanding the effects of neuromodulation.

Utility of hybrid PET/MRI multiparametric imaging in navigating SEEG placement in refractory epilepsy

“…The application of stereo-electroencephalography (SEEG) for the pre-surgical assessment of patients with refractory epilepsies is increasing, particularly for those with deep epileptic zones or foci distributed in both hemispheres [4]. SEEG can be regarded as the gold standard for SOZ localization, and a positive finding on SEEG recordings is usually indicative of a good outcome of surgical resection [5]. However, SEEG has limitations and entails risks for complications because of its invasive nature.…”

Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology

“…SEEG electrodes are similar in size and impedance to traditional DBS electrodes, can be implanted into many regions simultaneously, and can utilize externalized stimulators to test novel waveforms and adaptive-loop paradigms. This technique has been used in epileptic patients since the 1960s to record the onset and early spread of seizures (Youngerman et al, 2019). This history of being a well-tolerated and safe technique affords SEEG a particular advantage when considering its use in other protocols and paradigms.…”

Innovations in 3D Tissue Models of Human Brain Physiology and Diseases

“…These methods also suffer from low spatial and/or temporal resolution, as well as the need for large patient cohorts and consortia to identify the features of the human brain connectome related to normal aging or disease. [ 19–22 ]…”