Unit of Epileptology, Department of Neurosurgery, Sainte-Anne Hospital, 75014 Paris, France; Université Paris-Descartes, 75005 Paris, France; Service hospitalier Frédéric-Joliot, CEA/SAC/DSV/I2BM Neurospin, 91191 Gif/Yvette, France; Inserm U1023 IMIV, CEA, CNRS, université Paris-Sud, 91100 Orsay, France.
Université Pierre-et-Marie-Curie (Paris 6), 75013 Paris, France; Centre de référence des epilepsies rares, France; Brain and Spine Institute (ICM, Inserm, UMRS 1127, CNRS, UMR 7225), Paris, France.
Neurophysiol Clin. 2018 Feb;48(1):25-37. doi: 10.1016/j.neucli.2017.11.007. Epub 2017 Dec 15.
Stereoelectroencephalography (SEEG) aims to define the epileptogenic zone (EZ), to study its relationship with functional areas and the causal lesion and to evaluate the possibility of surgical therapy. Planning of exploration is based on the validity of the hypotheses developed from electroclinical and imaging correlations. Further investigations can refine the implantation plan (e.g. fluorodeoxyglucose positron emission tomography [FDG-PET], single photon emission computerized tomography [SPECT], magnetoencephalography [MEG] and high resolution electroencephalography [EEG-HR]). The scheme is individualized according to the features of each clinical case, but a general approach can be systematized according to the regions involved (temporal versus extra-temporal), the existence of a lesion, its type and extent. It takes account of the hemispheric dominance for language if this can be determined. In "temporal plus" epilepsies, perisylvian and insular regions are among the key structures to investigate in addition to mesial and neocortical temporal areas. In frontal lobe epilepsies, determining the functional and anatomical organization of seizures (anterior versus posterior, mesial versus dorsolateral) allows better targeting of the implantation. Posterior epilepsies tend to have a complex organization leading to multilobar and often bilateral explorations. In lesional cases, it may be useful to implant one or several intralesional electrode(s), except in cases of vascular lesions or cyst. The strategy of implantation can be modified if thermocoagulations are considered. The management of SEEG implies continuous monitoring in a dedicated environment to determine the EZ with optimal safety conditions. This methodology includes spontaneous seizure recordings, low and high frequency stimulations and, if possible, sleep recording. SEEG is applicable in children, even the very young. Specific training of medical and paramedical teams is required.
立体定向脑电图（SEEG）旨在确定致痫区（EZ），研究其与功能区和致病灶的关系，并评估手术治疗的可能性。探索规划基于从电临床和影像学相关性中发展出来的假设的有效性。进一步的研究可以改进植入计划（例如，氟脱氧葡萄糖正电子发射断层扫描 [FDG-PET]、单光子发射计算机断层扫描 [SPECT]、脑磁图 [MEG] 和高分辨率脑电图 [EEG-HR]）。该方案根据每个临床病例的特点进行个体化，但可以根据所涉及的区域（颞叶与颞叶外）、病变的存在、其类型和范围，对其进行系统的一般方法。如果可以确定，它会考虑语言的优势半球。在“颞叶加”癫痫中，除了内侧和新皮质颞叶区域外，围产期和岛叶区域也是需要研究的关键结构。在额叶癫痫中，确定发作的功能和解剖组织（前部与后部、内侧与背外侧）可以更好地确定植入的目标。后部癫痫往往具有复杂的组织，导致多叶甚至经常是双侧的探索。在病变病例中，除了血管病变或囊肿外，植入一个或多个病变内电极可能会有所帮助。如果考虑热凝，则可以修改植入策略。SEEG 的管理需要在专门的环境中进行持续监测，以在最佳安全条件下确定 EZ。这种方法包括自发发作记录、低频和高频刺激，如果可能的话，还包括睡眠记录。SEEG 适用于儿童，甚至是非常年幼的儿童。需要对医疗和辅助医疗团队进行特定的培训。
