The process follows the established expert opinion on the use of iEEG for extraoperative monitoring of epilepsy patients ( 11). Very often, this is the case when magnetic resonance imaging (MRI) is non-lesional that is, MRI has not revealed an obvious pathology capable of producing seizures (e.g., mesial temporal sclerosis, encephalomalacia, gray matter heterotopias, focal cortical dysplasia, polymicrogyria, low-grade neuroepithelial tumors, vascular malformations, or other structural lesions). In general, iEEG is considered when noninvasive testing has not unequivocally identified the EZ. ![]() The decision to use SEEG mapping always begins with considering whether the patient requires invasive EEG (iEEG) monitoring. Current Practice and Decision-Making for the Use of SEEG Stimulation MappingĮSM via SEEG is becoming an increasingly popular technique for localizing the EZ and eloquent cortex (EC) in patients with epilepsy requiring surgery. However, in the last decade, increased use of SEEG in the workup of surgical epilepsy by many North American centers has been matched by a parallel increased interest in the use of ESM as a complementary tool to SEEG recordings ( 10). SEEG ESM is therefore not a novel technique and has been utilized by French and other European centers for decades in the workup of surgical epilepsy ( 6– 9). Talairach and Bancaud started their investigations using SEEG stimulation during the mid-1960s, looking at motor responses from cingulate stimulation ( 4) and other mesial frontal lobe areas ( 5). ![]() They also defined the concept of the anatomico-electrico-clinical nature of the epileptogenic zone (EZ), proposing that the EZ is organized as a network with unique anatomic correlates, electrographic properties, and clinical manifestations ( 2, 3). During their time together at Hôpital Sainte Anne in Paris, France, they improved the methods used for the stereotactic implantation of electroencephalography (EEG) leads. The technique of SEEG ESM originated from the pioneers of SEEG itself, neurosurgeon Jean Talairach and neurologist Jean Bancaud. This review aims to provide insights into (1) the current practice and clinical decision-making for the application of SEEG stimulation mapping (2) clinical data and outcomes associated with this technique and (3) future applications of SEEG stimulation mapping for clinical practice and basic neuroscientific investigation. Also, it is not uncommon for local expertise and availability of these surgical services, at the treating center, to contribute to the preferential use of either SEEG or SD for extraoperative intracranial monitoring. the other is highly individualized to each patient, our review focuses on SEEG ESM. While both SEEG and SD ESM are appropriate techniques, and the decision to use one vs. The two conventional extraoperative invasive methods for obtaining this information are stereoelectroencephalography (SEEG) and subdural grids (SD). ![]() Finally, we briefly highlight future applications of SEEG ESM, including novel functional mapping approaches, identifying rare seizure semiologies, neurophysiologic investigations for understanding cognitive function, and its role in SEEG-guided radiofrequency thermal coagulation.Įlectrical stimulation mapping (ESM) is a vital component of the workup for epilepsy surgery, allowing for the determination of the functional cortex and helping to localize the epileptic network and its functional impact ( 1). ![]() We also summarize clinical data on the efficacy of SEEG stimulation in surgical outcomes and functional mapping. Here, we briefly review the current state of SEEG stimulation, with a focus on the techniques used for identifying the epileptogenic zone and eloquent cortex. Since the initial application of ESM in the mid-1960s, it remains unparalleled in defining eloquent brain areas and delimiting seizure foci for the purposes of surgical planning. 3Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United StatesĮlectrical stimulation mapping (ESM) using stereoelectroencephalography (SEEG) is an essential component in the workup of surgical epilepsy.2Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States.1School of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.Ojemann 2, Cornelia Drees 3 † and John A.
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