Epilepsy and paroxysmal conditions

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Stereoelectroencephalography in pre-surgical evaluation of patients with drug-resistant focal epilepsy


Background. Surgical treatment has shown its effectiveness for patients with drug-resistant focal epilepsy: resection or disconnection of the epileptogenic zone leads to relief from epileptic seizures. However, in some cases non-invasive examination may not be sufficient for localization of epileptogenic zone boundaries. Hence, such patients undergo invasive encephalography (EEG) to clarify zone location accounting for seizure development.

Objective: to evaluate effectiveness of invasive stereo-EEG in the diagnostics of drug-resistant focal epilepsy.

Material and methods. The data collected from 65 patients who underwent stereo-EEG during pre-surgical examination for pharmacoresistant focal epilepsy were retrospectively analyzed within the period of 2016–2019. According to the results of magnetic resonance imaging (MRI), 34 patients had MRI-negative forms of epilepsy, and 31 patients had MRI-positive forms with multiple structural changes in the brain or discrepancies between electro-clinical data and MRI findings.

Results. Based on the information obtained by stereo-EEG, 49 patients (75.4%) underwent resection operations. In 16 (24.6%) cases surgical treatment was not carried out due to detected bilateral epileptogenic zone, the lack of convincing data on its location or detecting an epileptogenic zone in a functionally significant region. In 44 operated patients, the follow-up comprised more than 12 months; it was not possible to contact 5 patients. Engel outcomes: I class – 27 (61.3%) patients, II class – 7 (15.9%), III class – 4 (9.1%), IV class – 6 (13.6%). As a result of stereo-EEG, hemorrhagic complications developed in 2 (3.1%) patients: epidural hematoma in 1 case (1.5%), and intracerebral hematoma in 1 case (1.5%). No persistent neurological deficit was noted during continued monitoring.

Conclusion. The method of stereo-EEG is effective for determining the epileptogenic zone boundaries in patients with drug- resistant focal epilepsy.

About the Authors

A. S. Balatskaya
Pirogov National Medical and Surgical Center
Russian Federation

Alexandra S. Balatskaya – MD, Neurologist, Department of Neurosurgery


N. V. Pedyash
Pirogov National Medical and Surgical Center
Russian Federation

Nikita V. Pedyash – MD, Neurosurgeon, Department of Neurosurgery


RSCI SPIN-code: 4659-3419

A. L. Golovteev
“Epilepsy Center” Neurological Clinic
Russian Federation

Alexander L. Golovteev – MD, Neurologist


N. A. Kalybaeva
“Epilepsy Center” Neurological Clinic
Russian Federation

Nazgul A. Kalybaeva – MD, Neurologist


N. P. Utyashev
Pirogov National Medical and Surgical Center
Russian Federation

Nikita P. Utyashev – MD, Neurologist, Department of Neurosurgery


M. A. Odeniyazova
Pirogov National Medical and Surgical Center
Russian Federation

Madina A. Odeniyazova – MD, Neurologist, Department of Neurosurgery


O. Yu. Bronov
Pirogov National Medical and Surgical Center
Russian Federation

Oleg Yu. Bronov – MD, PhD, Head of Department of Radiology


Scopus Author ID: 57215892759;

RSCI SPIN-code: 7429-7993

A. A. Zuev
Pirogov National Medical and Surgical Center
Russian Federation

Andrey A. Zuev – MD, PhD, Neurosurgeon, Head of Department of Neurosurgery


RSCI SPIN-code: 9377-4574


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For citations:

Balatskaya A.S., Pedyash N.V., Golovteev A.L., Kalybaeva N.A., Utyashev N.P., Odeniyazova M.A., Bronov O.Yu., Zuev A.A. Stereoelectroencephalography in pre-surgical evaluation of patients with drug-resistant focal epilepsy. Epilepsy and paroxysmal conditions. 2022;14(2):183-194. (In Russ.)

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