ArticleActa neurochirurgica2026
SEEG-guided therapeutic decision-making in drug-resistant epilepsy: retrospective analysis and clinical framework.
Article in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStereoelectroencephalography (SEEG) plays a central role in the presurgical evaluation of patients with drug-resistant epilepsy, particularly when noninvasive investigations are inconclusive. Beyond localization of the epileptogenic zone (EZ), its role in guiding therapeutic decision-making remains incompletely defined.
objectiveTo evaluate the safety, clinical outcomes, and therapeutic impact of SEEG, including SEEG-guided radiofrequency thermocoagulation (RF-TC), and to develop a structured clinical decision-making framework based on SEEG findings.
methodsWe performed a retrospective analysis of 71 consecutive patients with drug-resistant epilepsy who underwent SEEG monitoring between 2016 and 2025. Clinical, neuroimaging, and electrophysiological data were analyzed, along with procedural variables, complications, and outcomes following RF-TC and resective surgery. SEEG findings were used to stratify patients into distinct therapeutic pathways.
resultsA total of 958 electrodes were implanted (mean 14 ± 4.5 per patient). SEEG confirmed the preimplantation hypothesis in 85% of cases. Based on SEEG findings, 52% of patients were candidates for resective surgery, while 48% were managed conservatively or with neuromodulation strategies. RF-TC was performed in 37 patients (52%), resulting in seizure improvement in 73% at 12 months, although complete seizure freedom was limi. Response to RF-TC influenced subsequent treatment decisions, favoring conservative management in responders and resective surgery in non-responders. Favorable outcomes (Engel I-II) after resective surgery were achieved in 71% of patients at 12 months. Complications were predominantly minor, with a 1% rate of permanent neurological deficit.
conclusionsSEEG is a safe and effective tool not only for localizing the EZ but also for structuring therapeutic decision-making in drug-resistant epilepsy. SEEG findings enable patient stratification into individualized treatment pathways and support a dynamic, staged approach in which RF-TC may serve as both a therapeutic and decision-modulating tool. This framework highlights the evolving role of SEEG as a central platform in modern epilepsy surgery.
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