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#Stereo eeg how to#
How to cite this article: Jayabal V, Pillai A, Sinha S, Mariyappa N, Satishchandra P, Gopinath S, Radhakrishnan K.
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Advances in structural neuroimaging and post-processing techniques the human connectome project that non-invasively investigates brain connectivity using various MRI sequences and, specific intracerebral EEG patterns such as high frequency oscillations might more objectively assess epileptogenic brain foci in the future. In patients with drug-resistant focal epilepsies, especially those without an MRI-demonstrable lesion, MEG helps in localization of epileptogenic zone and networks by reinforcing the anatomo-electro-clinical hypothesis generated through other presurgical evaluation techniques and, SEEG helps to verify this hypothesis, thus enabling epilepsy surgery. Keywords: Drug-resistant epilepsy, epilepsy surgery, invasive electroencephalography evaluation, magnetoencephalography, magnetic source imaging, presurgical evaluation, source localization, stereo-electroencephalography Recent noninvasive techniques aimed at better structural imaging, delineating brain connectivity and recording specific intracerebral EEG patterns such as high frequency oscillations might decrease the need for SEEG but more importantly, make SEEG exploration more goal-directed and hypothesis-driven. Depending on the substrate pathology, there is > 80-90% chance of undergoing ES and 60-80% chance of becoming seizure-free following SEEG. Those who are otherwise destined to suffer from uncontrolled seizures and their consequences, SEEG guided ES is a worthwhile and a cost-effective option. When compared to subdural grid electrode recording, SEEG is less invasive and safer. Moreover, postoperative seizure freedom is better if MEG spike source localized cortical region is included in the resection. MEG has a dominant role in the presurgical evaluation of patients with MRI-negative DRFEs, insular epilepsies, and recurrent seizures after failed epilepsy surgeries, and in guiding placement of invasive electrodes. The sensitivity of MEG is much better in localizing the spiking zone in relation to lateral temporal and extratemporal cortical regions compared to the mesial temporal structures. In selected patients with drug-resistant focal epilepsies (DRFE), who otherwise are likely to be excluded from epilepsy surgery (ES) because of the absence of a magnetic resonance imaging (MRI)-demonstrable lesion or discordant anatomo-electro-clinical (AEC) data, magnetoencephalography (MEG) may help to generate an AEC hypothesis and stereo-electroencephalography (SEEG) may help to verify the hypothesis and proceed with ES.