SEEG in Epilepsy Surgery Evaluation: Current and Future Roles (Podcast)

Today in Cleveland Clinic’s Epilepsy Center, a good proportion of patients with medication-refractory seizures who are discussed at a patient management conference end up being referred for stereoelectroencephalography (SEEG) to inform the next steps in their management.

“None of the tests that are done up to the point of SEEG — including video EEG, MRI, nuclear imaging and others — capture information from the depths of the brain the way SEEG does,” says Demitre Serletis, MD, PhD, a neurosurgeon and neuroengineer with Cleveland Clinic’s Epilepsy Center. “This often makes the difference in guiding decision-making around whether to pursue epilepsy surgery and, if appropriate, how to plan the surgical approach.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Serletis updates listeners on the contemporary use of SEEG and where the technology is headed. He touches on the following, among other topics:

• The history and evolution of SEEG, including how it compares with subdural grids
• Patient selection for SEEG evaluation, including the role of the multidisciplinary patient management conference
• Essentials of SEEG electrode implantation and subsequent monitoring for seizures
• Risks of SEEG and its safety record
• The future of SEEG, including integration with machine learning, minimally invasive technologies, and potential applications for neuromodulation and gene therapy

Click the podcast player above to listen to the 31-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: So SEEG has been a technology for focal epilepsies and not generalized epilepsies, except in cases of focal leading to a secondary generalized epilepsy. Is that correct?

Demitre Serletis, MD, PhD: That’s right, although this field is evolving. SEEG did start out as more of an exploration for focal epilepsies. We still believe that even if we don’t see a lesion on the MRI scan — for example, in a subtle cortical dysplasia — these are still patients who benefit from SEEG because it allows us to make an electrical map of the architecture and the evolution of the seizure in its onset and spread, even in nonlesional cases. But now we are at the point where people are implanting into deeper structures like the thalamus in select patients with generalized epilepsy because information from the SEEG is being used to guide management with, for example, neuromodulation, which is now being applied in patients with Lennox-Gastaut syndrome and other generalized epilepsies. So it is an exciting time and SEEG is unlocking more doors than we anticipated 10 or so years ago.