Stereo-electroencephalography in the setting of a preexisting deep brain stimulation device: illustrative case.

BACKGROUND

Deep brain stimulation (DBS) and responsive neurostimulation are increasingly being used to treat drug-resistant epilepsy (DRE). However, patients who experience partial or limited improvement in seizure control could require additional surgical interventions or refinement of their epilepsy network characterization, including further stereo-electroencephalography (SEEG) investigations. SEEG in the setting of previously implanted hardware demonstrates a myriad of technical challenges. The authors present the first reported demonstration of SEEG electrode implantation with a preexisting DBS device.

OBSERVATIONS

The patient was a 36-year-old male with a history of severe DRE with focal impaired awareness seizures beginning at 7 years of age. Despite having a bilateral DBS device for the anterior nucleus of the thalamus, he continued to have 1-2 seizures per day and was offered SEEG. The patient tolerated the surgery well without any morbidity, with a successfully improved definition of his epilepsy network. SEEG allowed the medical team to titrate stimulation settings while following intracranial electrographic response.

LESSONS

SEEG in the setting of preexisting DBS can be performed safely without damage to functioning hardware, and the authors obtained characterization and localization of the epilepsy network. Further follow-up will be needed to assess the efficacy outcomes of additional intervention in this patient. https://thejns.org/doi/10.3171/CASE24854.