Ask The Experts On Demand Webinar: SEEG Interpretation from Interictal to Ictal: Navigating the Path to Surgical Decision-Making in Temporal Lobe Epilepsy-ATEWSEEG Interpretation from Interictal to Ictal: Navigating the Path to Surgical Decision-Making in Temporal Lobe Epilepsy

ATEWSEEG Interpretation from Interictal to Ictal: Navigating the Path to Surgical Decision-Making in Temporal Lobe Epilepsy

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Video Summary

This AES expert webinar focused on stereo-electroencephalography (SEEG) interpretation in temporal lobe epilepsy (TLE) and surgical decision-making. Dr. Brigitte Faucher detailed subtypes of TLE, emphasizing careful analysis of both interictal and ictal SEEG patterns. Key interictal features include background rhythms, spikes, spike-gamma activity, and high-frequency oscillations (HFOs), which improve localization of the epileptogenic zone. Spike-gamma preceding spikes emerges as a promising biomarker for surgical outcomes. Ictal interpretation stresses the importance of identifying true seizure onset zones and differentiating propagation patterns, with low-voltage fast activity linked to better outcomes. Visual and quantitative EEG features aid prediction of surgical success, highlighting that precise sublobar classification of TLE guides optimal resection strategies. Dr. Chen Wu addressed surgical therapies, underscoring anterior temporal lobectomy (ATL) as the gold standard, offering 60-80% seizure freedom with long-term durability. Minimally invasive alternatives like laser interstitial thermal therapy (LIT) serve as selective amygdalohippocampectomies, with roughly 65% short-term seizure freedom and lower morbidity, though long-term outcomes remain under study. Correct patient selection is vital, especially regarding mesial temporal sclerosis and temporal plus epilepsies involving insula, where SEEG-guided approaches with RF ablation or neuromodulation (responsive neurostimulation, deep brain stimulation) play roles. Interactive Q&A highlighted nuanced surgical decisions based on seizure onset localization, dominant hemisphere cognitive risks, and stimulation protocols for seizure induction. Overall, combined expert interpretation of SEEG data and tailored surgical/neuromodulation strategies are essential to optimize outcomes in complex temporal lobe epilepsy cases.

Keywords

stereo-electroencephalography

temporal lobe epilepsy

SEEG interpretation

interictal features

ictal onset zones

spike-gamma biomarker

anterior temporal lobectomy

laser interstitial thermal therapy

mesial temporal sclerosis

neuromodulation therapies