image: Stereoelectroencephalography in temporal lobe epilepsy: clinical characteristics, influential factors, and surgical outcomes
Credit: ©Science China Press
“Much like tuning a high-precision radar to detect faint signals, SEEG enables clinicians to record subtle electrical signatures of seizures directly from deep brain structures,” says Dr. Jiajie Mo, first author and neurosurgeon at Beijing Tiantan Hospital. “In our study, we found that one such signature (low-frequency high-amplitude periodic spikes, LFPS) not only reflects seizure onset zones, but also predicts better outcomes after surgery, especially when accompanied by hippocampal atrophy on MRI.”
The research team demonstrated that the combination of LFPS pattern and hippocampal atrophy independently predicted seizure freedom following anterior temporal lobectomy (ATL), with adjusted odds ratios (aOR) of 4.62 and 4.03, respectively. Moderation analysis further revealed that the two factors interact to yield a conditional effect on surgical outcomes, offering a powerful tool for patient selection.
“Interestingly, while many SEEG features are observed across patients, only specific patterns like LFPS are clinically meaningful in predicting outcomes,” adds Prof. Zhang. “This underscores the importance of combining SEEG signals with structural imaging findings to enhance decision-making in difficult cases.”
The researchers also performed a propensity score matching (PSM) analysis to compare outcomes between TLE patients who underwent ATL with or without SEEG evaluation. The matched analysis showed no significant differences in seizure freedom (P = 0.26), memory function (P = 0.37), or medication use (P = 0.92) between the two groups, suggesting that SEEG can be safely used without compromising functional outcomes, particularly in diagnostically challenging cases. The SEEG recordings were obtained as part of the presurgical evaluation for patients with drug-resistant epilepsy. SEEG involves implanting thin electrodes into the brain to capture seizure activity directly from deep cortical and subcortical regions. “For many of these patients, especially those with non-concordant imaging or suspected bilateral epilepsy, SEEG provides the only reliable path to defining the epileptogenic zone,” explains Dr. Mo.
This extensive cohort, spanning eight years and two surgical centers, not only affirms the safety and utility of SEEG, but also provides new directions for individualized surgical planning. “We hope this work will contribute to more precise and data-driven epilepsy surgery protocols,” Prof. Zhang concludes.