Intracranial EEG in the 21st Century

Author:

Jobst Barbara C.1ORCID,Bartolomei Fabrice23,Diehl Beate4,Frauscher Birgit5,Kahane Philippe6,Minotti Lorella6,Sharan Ashwini7,Tardy Nastasia6,Worrell Gregory8,Gotman Jean5ORCID

Affiliation:

1. Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Hanover, NH, USA

2. Aix Marseille University, INSERM, INS, Inst Neurosci Syst, Marseille, France

3. APHM, Timone hospital, Epileptology department, Marseille, France

4. National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom

5. Montreal Neurological Institute & Hospital, McGill University, Montreal, Quebec, Canada

6. Neurology Department & INSERM U1216, Grenoble-Alpes University and Hospital, Grenoble, France

7. National Hospital for Neurology and Neurosurgery, Jefferson University, Philadelphia, PA, USA

8. Mayo Clinic, Rochester, MN, USA

Abstract

Intracranial electroencephalography (iEEG) has been the mainstay of identifying the seizure onset zone (SOZ), a key diagnostic procedure in addition to neuroimaging when considering epilepsy surgery. In many patients, iEEG has been the basis for resective epilepsy surgery, to date still the most successful treatment for drug-resistant epilepsy. Intracranial EEG determines the location and resectability of the SOZ. Advances in recording and implantation of iEEG provide multiple options in the 21st century. This not only includes the choice between subdural electrodes (SDE) and stereoelectroencephalography (SEEG) but also includes the implantation and recordings from microelectrodes. Before iEEG implantation, especially in magnetic resonance imaging -negative epilepsy, a clear hypothesis for seizure generation and propagation should be based on noninvasive methods. Intracranial EEG implantation should be planned by a multidisciplinary team considering epileptic networks. Recordings from SDE and SEEG have both their advantages and disadvantages. Stereo-EEG seems to have a lower rate of complications that are clinically significant, but has limitations in spatial sampling of the cortical surface. Stereo-EEG can sample deeper areas of the brain including deep sulci and hard to reach areas such as the insula.  To determine the epileptogenic zone, interictal and ictal information should be taken into consideration. Interictal spiking, low frequency slowing, as well as high frequency oscillations may inform about the epileptogenic zone. Ictally, high frequency onsets in the beta/gamma range are usually associated with the SOZ, but specialized recordings with combined macro and microelectrodes may in the future educate us about onset in higher frequency bands. Stimulation of intracranial electrodes triggering habitual seizures can assist in identifying the SOZ. Advanced computational methods such as determining the epileptogenicity index and similar measures may enhance standard clinical interpretation. Improved techniques to record and interpret iEEG may in the future lead to a greater proportion of patients being seizure free after epilepsy surgery.

Publisher

SAGE Publications

Subject

Neurology (clinical)

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