Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15238, USA.
Department of Neurological Surgery, School of Medicine, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
Neurotherapeutics. 2019 Jan;16(1):59-66. doi: 10.1007/s13311-018-00703-2.
Accurate and safe localization of epileptic foci is the crux of surgical therapy for focal epilepsy. As an initial evaluation, patients with drug-resistant epilepsy often undergo evaluation by noninvasive methods to identify the epileptic focus (i.e., the epileptogenic zone (EZ)). When there is incongruence of noninvasive neuroimaging, electroencephalographic, and clinical data, direct intracranial recordings of the brain are often necessary to delineate the EZ and determine the best course of treatment. Stereoelectroencephalography (SEEG) and subdural electrodes (SDEs) are the 2 most common methods for recording directly from the cortex to delineate the EZ. For the past several decades, SEEG and SDEs have been used almost exclusively in specific geographic regions (i.e., France and Italy for stereo-EEG and elsewhere for SDEs) for virtually the same indications. In the last decade, however, stereo-EEG has started to spread from select centers in Europe to many locations worldwide. Nevertheless, it is still not the preferred method for invasive localization of the EZ at many centers that continue to employ SDEs exclusively. Despite the increased dissemination of the SEEG method throughout the globe, important questions remain unanswered. Which method (SEEG or SDEs) is superior for identification of the EZ and does it depend on the etiology of epilepsy? Which technique is safer and does this hold for all patient populations? Should these 2 methods have equivalent indications or be used selectively for different focal epilepsies? In this review, we seek to address these questions using current invasive monitoring literature. Available meta-analyses of observational data suggest that SEEG is safer than SDEs, but it is less clear from available data which method is more accurate at delineating the EZ.
准确、安全的致痫灶定位是局灶性癫痫手术治疗的关键。作为初始评估，耐药性癫痫患者通常需要通过非侵入性方法评估以确定癫痫灶（即致痫区（EZ））。当神经影像学、脑电图和临床数据不一致时，通常需要直接进行颅内脑电记录以描绘 EZ 并确定最佳治疗方案。立体脑电图（SEEG）和硬膜下电极（SDEs）是直接从皮层记录以描绘 EZ 的两种最常见方法。在过去几十年中，SEEG 和 SDEs 几乎仅在特定地理区域（即法国和意大利用于立体 EEG，其他地方用于 SDEs）用于相同的适应证。然而，在过去十年中，立体 EEG 已开始从欧洲的一些中心扩展到全球许多地方。尽管立体 EEG 方法在全球范围内的传播有所增加，但仍有许多中心继续仅使用 SDEs 作为 EZ 侵入性定位的首选方法，许多重要问题仍未得到解答。哪种方法（SEEG 或 SDEs）更适合确定 EZ，它是否取决于癫痫的病因？哪种技术更安全，是否适用于所有患者人群？这两种方法是否具有同等的适应证，或者应选择性地用于不同的局灶性癫痫？在这篇综述中，我们试图使用当前的侵袭性监测文献来回答这些问题。现有的观察性数据荟萃分析表明，SEEG 比 SDEs 更安全，但从现有数据来看，哪种方法更能准确描绘 EZ 还不清楚。
