Abstract
Electrical stimulation mapping (ESM) using stereoelectroencephalography (SEEG) is an essential component in the workup of surgical epilepsy. 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. 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. We also summarize clinical data on the efficacy of SEEG stimulation in surgical outcomes and functional mapping. 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.
Highlights
Electrical 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]
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
They defined the concept of the anatomico-electricoclinical 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]
Summary
Electrical 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]. The two conventional extraoperative invasive methods for obtaining this information are stereoelectroencephalography (SEEG) and subdural grids (SD) While both SEEG and SD ESM are appropriate techniques, and the decision to use one vs the other is highly individualized to each patient, our review focuses on SEEG ESM. The sub-hertz low-frequency stimulation used in SPES elicits electroepileptiform activity without inducing a clinical response [23] This protocol has been applied to several epileptic pathologies, including type I and II cortical dysplasia, hippocampal sclerosis, and polymicrogyria [23]. Given the limitations of SEEG and SD and the lack of comparative studies on SEEG and SD ESM, the functional mapping strategy must be individualized for each patient
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