Jaffee Stephen, Gupta Navnika, Kramer Dallas, Kusyk Dorian M, Valeriano James, Merkley Amanda, Kite Trent, Arora Shaifali, Grover Pulkit, Whiting Alexander C
Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania.
Department of Neurology, Allegheny Health Network Neuroscience Institute, Pittsburgh, Pennsylvania.
J Neurosurg Case Lessons. 2025 Apr 28;9(17). doi: 10.3171/CASE24854.
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.
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.
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.
深部脑刺激（DBS）和反应性神经刺激越来越多地用于治疗药物难治性癫痫（DRE）。然而，癫痫发作控制仅部分改善或改善有限的患者可能需要额外的手术干预或完善其癫痫网络特征描述，包括进一步的立体定向脑电图（SEEG）检查。在先前已植入硬件的情况下进行SEEG存在诸多技术挑战。作者首次报道了在已有DBS装置的情况下进行SEEG电极植入的演示。
该患者为一名36岁男性，有严重DRE病史，7岁起出现局灶性意识障碍性癫痫发作。尽管已植入双侧丘脑前核DBS装置，但他仍每天发作1-2次，遂接受SEEG检查。患者对手术耐受性良好，未出现任何并发症，成功改善了其癫痫网络的特征描述。SEEG使医疗团队能够在跟踪颅内脑电图反应的同时调整刺激参数。
在已有DBS的情况下进行SEEG可以安全实施，不会损坏正常运行的硬件，作者获得了癫痫网络的特征描述和定位。需要进一步随访以评估该患者额外干预的疗效结果。https://thejns.org/doi/10.3171/CASE24854 。
