Living with epilepsy, especially when seizures aren’t well-controlled by medication, can feel like walking a tightrope. There’s the constant uncertainty, the worry about when the next one might happen. It’s a heavy burden, I know. Sometimes, despite our best efforts with standard tests, we need a deeper look to understand exactly where these seizures are starting in the brain. That’s where a remarkable procedure called Stereoelectroencephalography (SEEG) comes into the picture. It’s a bit of a mouthful, I agree! But it can be a really valuable tool.
So, What is Stereoelectroencephalography (SEEG) Exactly?
Alright, let’s break down what Stereoelectroencephalography (SEEG) is. Think of it as a highly specialized detective mission for the brain. It’s a type of minimally invasive surgery where skilled neurosurgeons – that’s brain surgeons – carefully place tiny wires called electrodes deep inside specific areas of your brain. These electrodes can reach places that a regular electroencephalogram (EEG), the kind where electrodes are placed on your scalp, just can’t.
Once these electrodes are in place, you’d stay in the hospital for a bit. During this time, a dedicated epilepsy team (doctors and nurses specializing in seizures) would monitor your brain’s electrical activity, waiting to record any seizures you might have. The whole point? To pinpoint the exact spot in your brain where those troublesome seizures are kicking off. This information is gold because it helps us figure out if a more targeted treatment, like surgery to remove the small area of brain cells causing the seizures (we call this a resection), could be an option for you. Sometimes, SEEG is also used during the surgery itself or to guide other epilepsy therapies.
When Do We Consider SEEG?
You might be wondering, “Is this for me or my loved one?” Well, SEEG (or stereotactic EEG, as it’s also known) is most often considered for adults and children over two years old who have what we call drug-resistant epilepsy, sometimes termed refractory epilepsy. This means their seizures haven’t responded well to at least two different anti-seizure medications or other standard medical treatments. It’s a tough spot to be in, and that’s why we look for more advanced options.
Your specialist might also suggest SEEG if they need to map out important brain areas – like those controlling senses, movement, or language – to make sure they’re protected during any potential brain surgery.
And sometimes, SEEG is part of the treatment itself. For example:
- Radiofrequency thermocoagulation: This uses radio waves and heat to carefully target and quiet down the brain cells causing seizures.
- Thermoablation (or LITT): Similar idea, using heat energy to address the seizure-starting areas.
- Responsive neurostimulation: This is a clever device that can deliver tiny electrical pulses to the specific area where seizures begin, often helping to stop them in their tracks.
Could SEEG Be an Option for You?
About one in five people with complex focal epilepsy – that means seizures starting in one specific area of the brain – might have SEEG. This is especially true if other tests, like an MRI (magnetic resonance imaging) scan, haven’t given us a crystal-clear picture of where the seizures are coming from.
It’s important to know that if you have generalized epilepsy, where seizures seem to start in many areas of the brain at once, SEEG usually isn’t the right fit.
So, your doctor might talk about SEEG if:
- You’re being considered as a candidate for epilepsy surgery.
- You experience focal seizures or complex partial seizures that aren’t well-controlled by at least two medications.
- Other tests haven’t provided clear enough answers.
How is SEEG Different from a Regular EEG?
You’ve probably heard of an EEG, right? Many of my patients have. It’s a common test where small metal discs (electrodes) are attached to your scalp to record brain waves. An EEG is often the first step and is generally more suitable for very young children, like infants under two.
Think of an EEG as phase one in our detective work. If the results from an EEG are a bit fuzzy, or if the neurosurgeon needs a much more detailed map, then SEEG might be recommended as phase two.
The main differences with SEEG are:
- It can monitor a much larger area of your brain.
- The electrodes are placed much deeper inside the brain.
Because SEEG records activity from different depths and potentially both sides (hemispheres) of your brain, it gives us a much more precise location of where those seizures are beginning. And yes, children older than two can have this procedure safely.
Interestingly, some studies have shown that patients who have SEEG before epilepsy surgery tend to spend less time in the operating room compared to those who have a different type of invasive EEG (called subdural intracranial EEG, where electrodes are placed on the surface of the brain after a larger opening is made). They also often have shorter hospital stays and might need less pain medication after SEEG.
Understanding the SEEG Journey: What to Expect
If SEEG is being considered, your care team will walk you through everything. It’s a big decision, and we want you to feel informed.
Before the SEEG Procedure
Usually, there are some preparatory steps. This often includes other tests to make sure surgery is a safe option for you. Your specialist might order:
- A blood test.
- An electrocardiogram (EKG) to check your heart.
- Imaging tests like a CT (computed tomography) scan and an MRI.
I know people often worry about hair shaving, or about reducing or stopping their anti-seizure medication before the procedure. These are completely valid concerns. Please, talk to your care team about anything on your mind. We’ll work together to make you (or your child) as comfortable and stress-free as possible.
During the SEEG Procedure
The SEEG surgery itself usually takes about four to six hours. On the day of the test, an anesthesiologist (a doctor specializing in anesthesia) will give you medication to help you sleep. You’ll be completely asleep during the procedure and won’t feel any pain.
Once you’re asleep, the surgical team will:
- Place a special frame, called a stereotactic frame, on your head. This helps keep your head perfectly still, which is crucial for precision.
- Make about 10 to 20 tiny openings in your scalp – each about the width of a piece of spaghetti. This is done very carefully to avoid bleeding.
- Gently insert the thin, flexible electrodes through these small openings.
- Use advanced imaging to guide these electrodes to the precise areas in your brain where previous tests suggest your seizures might be starting.
- Once the electrodes are in place, the head frame is removed, and your head is bandaged.
- You’ll then be taken to the recovery room, and you’ll likely have a CT scan and an X-ray of your skull to double-check the exact placement of the electrodes.
After the SEEG Procedure
Following the SEEG electrode placement, you’ll typically be moved to a special area of the hospital called an Epilepsy Monitoring Unit (EMU). Here, a team will closely observe you for any seizure activity. The electrodes will be connected to equipment that records your brain’s electrical activity. A computer then helps create 3D images showing exactly where your seizures start and how they spread. This is the detective work in action!
How long you stay in the hospital can vary – it might be a few days, or it could be a few weeks. It really depends on how often you usually have seizures, as we need to capture them to get the information we need. The average stay is often around one week.
When the monitoring period is over, removing the electrodes is a much simpler process. It usually takes about 10 to 15 minutes and is done under local anesthesia, meaning you’ll be awake, but the area will be numb.
What About Risks or Side Effects?
SEEG is generally considered a safe procedure, but like any brain surgery, even a minimally invasive one, there are potential risks. It’s important we talk about these honestly. They include:
- Bleeding in the brain (we call this an intracranial hemorrhage).
- Infection.
- Stroke.
Your team will discuss these with you in detail, and they take every precaution to minimize these risks.
How Long is Recovery?
Your care team will give you specific advice on what to expect during recovery and when you can get back to your usual routine. Typically, people feel much better within about 24 to 48 hours after the electrode placement.
What Do We Learn from SEEG?
The results from SEEG really depend on what your team observes during the monitoring period. The good news is that in most cases, SEEG is very successful in locating the source of the seizures.
Specialists will carefully review all the recorded brain activity. Based on this, they’ll figure out if surgery or other specific treatments for your epilepsy could be beneficial. If surgery is the recommended path, it usually happens about four to eight weeks after the SEEG, giving you plenty of time to recover from the electrode placement.
When Will I Know the Results?
You might get some early insights before you even leave the hospital. But before any final treatment plan is decided, you and your loved ones will have dedicated time to go over all the final results with your care team and ask all your questions. We’re in this together.
Key Things to Remember About Stereoelectroencephalography (SEEG)
- SEEG is a specialized test: It helps find the exact starting point of hard-to-treat seizures deep in the brain.
- It’s for specific situations: Often used when medications haven’t worked well for focal epilepsy and other tests aren’t clear.
- Minimally invasive: Tiny electrodes are placed through small openings.
- Guides treatment: The information from SEEG helps decide if targeted surgery or other therapies might help control your seizures.
- Team approach: A whole team of specialists is involved in your care.
- Discuss your concerns: Always talk to your doctor about any questions or worries you have.
