What is stereoelectroencephalography (SEEG)?

Stereoelectroencephalography (SEEG) is a minimally invasive surgical procedure where one can understand the beginning of hard-to-control epileptic seizures in your brain. The neurosurgeon places electrodes in parts of your brain that an ordinary electroencephalogram (EEG) cannot reach. After the insertion of the electrodes, you will stay in the hospital as an epilepsy team records your seizures.

SEEG helps your epilepsy team determine whether you could be treated with only targeted therapies, including surgery, such as resection of areas responsible for seizures within your brain. Your doctor may use SEEG in the operating room or other treatments for epilepsy.

What is an SEEG procedure used for?

Neurosurgeons most commonly determine if adults and children over 2 years of age who have drug-resistant, also known as refractory epilepsy, are surgical candidates. Refractory epilepsy is a condition whereby the seizures cannot be controlled by two or more prescribed antiseizure medications or other medical treatments.

Your specialist may use SEEG before any brain surgery to map out those areas of the brain that should be preserved during the operation, including sensory, motor, and language functions.

Or you can be one of those patients, who get SEEG as treatment, including:

• Radiofrequency thermocoagulation involves killing brain cells connected with the seizure process via radio waves and heat energy.
• Thermoablation, also known as LITT (laser interstitial thermal therapy), destroys areas of the brain that cause seizures using heat energy.
• Responsive neurostimulation: This is a procedure in which stimulation is provided to the area where seizures initiate; this area is called seizure focus.

Do I have qualifications for stereoelectroencephalography?

About 20% of those with complex focal epilepsy, that is, those who experience seizures in one of the brains, are usually given SEEG if their MRI or magnetic resonance imaging presents unclear results. You will not be qualified if you have generalized epilepsy; your seizures happen in multiple parts of your brain.

Your specialist will give you this tests if you:

• Is a candidate for surgery for epilepsy.
• Have focal seizures or complex partial seizures that medication treatment or at least two medications are not effective at treating.
• Receive ambiguous results from other tests.

What is the difference between EEG SEEG?

The differences between SEEG EEG are:

• Reaches a larger area of your brain.
• Places electrodes at sites more profound in your brain.

During an EEG, your provider attaches electrodes small metal discs to your skull to record electrical activity. An EEG is typically better for children and infants under age 2.

Typically, you will receive an EEG as a phase 1 test to determine the seizure-onset zone. They may then recommend that you undergo SEEG as phase 2 if the results are inconclusive or more information is needed to decide on any course of action.

Because SEEG records activity from areas on each side (hemispheres) of your brain at various depths, your provider is able to pinpoint more accurately where the seizure starts. This procedure can be safely performed in children aged 2 years or more.

One of the groups of subjects who underwent epilepsy surgery received SEEG before surgery and spent much less time in the operating room than another group who had specialized EEG, known as subdural intracranial EEG, where electrodes are put on the exposed surface of their brains. They also spent much less time in the hospital for SEEG and were prescribed fewer medications to control pain.

What can I expect before SEEG?

Your care team educates you on how to prepare for SEEG. This generally comprises other tests to see if you are fit for surgery. Your specialist might recommend to you:

• Blood test.
• Electrocardiogram (EKG).
• Imaging tests like CT or MRI.

You are going to be worried about the fact that all or some of your hair is going to be shaved, or that all or some of your child's hair, will be shaved off. Or you are just curious about what to do with your meds-meaning, should you cut down on or stop them before SEEG?

Before surgery, talk to your care team about any concerns or questions you have. The staff works closely with you to make you and your child as comfortable and stress-free as possible.

What to Expect during Test?

SEEG surgery usually takes four to six hours. You will receive medication from your anesthesiologist on the day of your test. You will sleep through the procedure, feeling no pain.

In minutes after you fall asleep, your surgical team:

• It secures a rigid (stereotactic) frame to your head so it does not move during the procedure.
• Drills small holes (about the size of a spaghetti noodle) about 10-20 in your scalp, allowing several electrodes to be inserted without bleeding.
• Small electrodes are placed- the flexible pieces of plastic attached to wires- through the holes.
• Placing the electrodes in areas of your brain where earlier testing indicates your seizures originate.
• She will remove the head frame and bandages.
• We will take you to the recovery room, where you will receive a CT scan and X-ray of your skull for localization of the placement of electrodes.

What can I expect after SEEG Test?

You usually spend time in an Epilepsy Monitoring Unit after SEEG. A team follows your activities and marks down any seizure activity. The electrodes were attached to equipment that recorded your brain activity. From these registrations, a computer produced 3D images outlining the onset and spread of your seizures.

You may need to spend several days or weeks in the hospital, depending on how often you are experiencing seizures. Most people stay for one week. When the evaluation is finished, your team will painlessly remove the electrodes in a procedure that takes 10 to 15 minutes under local anaesthesia.

What are the risks of SEEG? Are there side effects?

SEEG is safe, but like all brain surgeries, the procedure carries risks. There is:

• You are bleeding in your brain (brain bleed or intracranial haemorrhage).
• Infection.
• Stroke.

How long is it before feeling better after the procedure with SEEG?

Your care team will be better able to discuss when you may start to feel normal again and when you can resume your daily routine. Most patients start to feel better within 24 to 48 hours.

What can I expect from a SEEG?

The results of a SEEG depend on what the care team learns from monitoring. In fact, most SEEG results successfully identify the focus of the seizure. As for you, the specialist will study the recorded brain activity and recommend whether you should undergo surgery or another treatment for epilepsy. Treatment by surgery for epilepsy usually takes place four to eight weeks after a SEEG. Therefore, there is enough time for recovery.

How soon will I know about my SEEG results?

If the initial results are before you are discharged from the hospital, you may have the opportunity to discuss the final results with your care team before finalizing treatment plans.

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