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Cognitive Mapping Using SEEG and SDE for Personalized Epilepsy Surgery
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| Subject:
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Brain Mapping Applications in Epilepsy – Across Pediatric and Adult Populations
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Presenter Author:
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Mahla Sirjani
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Author:
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Mahla Sirjani - Corresponding - Presenter
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| Affiliation 1:
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Department of Biology, Islamic Azad University of Mashhad
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Abstract
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Original Research
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introduction :
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Background
Epilepsy accounts for approximately 0.75% of the global burden of disease and was associated with an estimated 20.6 million disability-adjusted life years in 2012 (1). For patients with drug-resistant epilepsy, surgery offers the possibility of achieving seizure freedom.
However, a major challenge is to resect sufficient epileptogenic tissue while preserving adjacent eloquent cortical and subcortical regions to minimize postoperative cognitive and functional deficits. In this context, cognitive mapping using stereoelectroencephalography (SEEG) has become an important approach for identifying functionally critical brain regions (2).
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Methods:
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Methods
This narrative review summarizes recent advances in cognitive mapping using SEEG and compares its applications with subdural electrode (SDE) mapping.
Robotic-assisted SEEG implantation has improved targeting precision and expanded access to deep and previously difficult-to-sample brain regions (4).
SDE provides dense coverage of the cortical surface, particularly the lateral cortex, whereas SEEG offers targeted three-dimensional sampling with access to deep and medial structures (2,4). In addition, high-frequency activity (HFA) mapping has emerged as a complementary, stimulation-independent approach for identifying functionally relevant cortical regions. Task-induced HFA during SEEG can provide information that complements direct cortical stimulation (DCS), although its clinical sensitivity and role remain under investigation (5).
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Results:
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Results
Current evidence suggests that SEEG has a favorable safety profile and, in selected patients, may be associated with comparable or more favorable seizures outcome than SDE (3). However, the comparative effectiveness of SEEG-based language mapping in preventing postoperative language impairment remains incompletely established (4,6).
Electrical stimulation remains an important reference method for defining eloquent language cortex, while SEEG-based mapping may help characterize distributed language networks (6). Importantly, emerging evidence indicates that resection of high-gamma modulation (HGM)-positive but stimulation-negative tissue may be associated with postoperative cognitive deficits, highlighting the potential clinical value of HGM mapping as an adjunct to conventional electrical stimulation mapping (7).
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Conclusion:
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Conclusion
SEEG-guided cognitive mapping represents an important step toward personalized epilepsy surgery. Its ability to sample deep brain structures, together with the precision of modern implantation techniques and complementary information from electrophysiological mapping, may improve identification of both epileptogenic and functionally critical neural networks.
Nevertheless, prospective studies are needed to establish standardized mapping protocols and to directly compare language and cognitive outcomes between SEEG and SDE-based approaches across diverse patient populations.
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| Attachment:
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| Keywords:
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Keywords Epilepsy; Brain mapping; Cognition; Electroencephalography; Language; Neurosurgical Procedures
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