Epilepsy is a really frustrating condition, isn't it? Sometimes it's very difficult to control it even with medication. So if you have such a problem, this SEEG that we're going to talk about today may be something that can bring you new hope. Let's see what it is?
What is SEEG (Stereoelectroencephalography)? Simply put...
Simply put, SEEG (Stereoelectroencephalography) is a slightly advanced test that helps you find exactly where in your brain your epilepsy is starting. It's like surgery, but it's done very small, without making a big incision.
You've probably heard of a regular EEG (electroencephalogram). It measures the electrical activity of your brain from the surface of your head. But with a SEEG, neurosurgeons insert tiny electrodes into the deeper layers of your brain. This allows it to detect seizures that may not be picked up by a regular EEG, and that start deep in your brain.
After these electrodes are inserted, you will be kept in a special unit in the hospital for a few days, and a team of epilepsy doctors will monitor your seizures. This will help them understand exactly what is causing your epilepsy and where in the brain it starts.
Imagine, like a detective, this SEEG helps find the root of epilepsy hidden deep within the brain!
When is a SEEG test performed?
Doctors recommend a SEEG test, especially in the following cases:
- For people with drug-resistant epilepsy: For some people, even two types of epilepsy medications don't work well. For such people, this SEEG test is very important to determine whether surgery can be performed to remove the part of the brain that is causing the epilepsy.
- Mapping important areas before brain surgery: Sometimes, before brain surgery, it is necessary to know exactly which areas of the brain are important for things like speech and movement. Then, during the surgery, those areas can be protected without damaging them. SEEG can help with that too.
- As a guide to other treatments:
- (Radiofrequency thermocoagulation): This uses radio waves and heat energy to destroy brain cells that cause epilepsy.
- (Thermoablation) or (Laser Interstitial Thermal Therapy - LITT): In this case, heat energy is used to destroy the parts of the brain that cause epilepsy.
- (Responsive neurostimulation): In this, stimulation is provided to the point where the seizure begins (seizure focus).
Before such treatments are given, SEEG is used to pinpoint the exact location of the seizure. This is a test that can be performed on children over two years of age and adults.
Am I eligible for a SEEG test? How do I know?
Not every epilepsy patient needs SEEG. Doctors recommend it after considering certain factors.
Typically, about 20% of people with focal epilepsy are referred for SEEG only if other tests, such as an MRI (Magnetic Resonance Imaging), are inconclusive. If you have generalized epilepsy, you are not eligible for this test.
Your specialist may recommend this test for the following reasons:
- If you might be a good candidate for surgery for epilepsy.
- If you have focal or complex partial seizures, and they are not well controlled with one or two medications.
- If the results of other tests are not clear.
What is the difference between a regular EEG and a SEEG?
The main differences between the two are:
- SEEG covers a large area of your brain.
- In SEEG, electrodes are sent to the deeper layers of the brain .
A typical EEG involves attaching small metal plates (electrodes) to the surface of your skull to record the electrical activity of your brain. For infants and children under two years of age, an EEG is often more appropriate than a SEEG.
Most often, an electroencephalogram (EEG) test (a `phase 1 test`) will be done first. This will try to find out where your epilepsy is starting. However, if those results are not clear, or if the neurosurgeon needs more information, they may recommend a SEEG (a `phase 2 test`).
Because SEEG captures information from different depths in both hemispheres of the brain, it is easier for the doctor to localize the exact location of the seizure.
One study found that people who had SEEG before epilepsy surgery spent less time in the operating room than those who had a specialized EEG called subdural intracranial EEG. Those who had SEEG also had shorter hospital stays and fewer pain medications.
What happens before the SEEG test? What should I expect?
Your medical team will advise you on how to prepare for your SEEG. This will usually include a few more tests to see if you are a good candidate for surgery. For example:
- Blood tests.
- A heart rate test (Electrocardiogram - EKG)
- Imaging tests such as `(CT scan)` (Computed Tomography scan) and `(MRI)`.
You may be worried about whether you or your child's hair will be cut, or whether they will need to reduce or stop their epilepsy medication before the SEEG.
Discuss any fears, doubts, or questions you may have with your medical team before the surgery. They will help keep you and your baby as relaxed and stress-free as possible.
What happens during SEEG surgery?
The SEEG procedure usually takes about four to six hours . On the day of the procedure, the anesthesiologist will give you anesthesia. You will be completely asleep, so you will not feel any pain.
After you are asleep, the surgical team will do the following:
- A rigid frame (stereotactic frame) is attached to your head to keep it still.
- They will make about 10 to 20 small holes in your scalp, about the width of a spaghetti string . This will not cause any bleeding.
- Electrodes (connected to wires), which look like small, flexible pieces of plastic, are inserted through these holes.
- These electrodes are placed in the areas of your brain where previous tests have shown that your epilepsy is starting.
- The head frame is removed and a bandage is placed on the head.
- Then you will be taken to the recovery room, where you will have a CT scan and an X-ray of your skull to see exactly where the electrodes are.
What happens after SEEG?
After the SEEG, you will usually be referred to an Epilepsy Monitoring Unit (EMU). There, a team of doctors will monitor you for epileptic seizures. The electrodes are connected to devices that record your brain activity. A computer then creates 3D images that show how your seizures start and progress.
Depending on how often you have epileptic seizures, you may need to stay in the hospital for a few days to a few weeks . Usually, you will stay for about a week. Once all the tests are done, your medical team will remove your electrodes. It is a very simple procedure that takes about 10 to 15 minutes and is done under local anesthesia.
Are there any risks of the SEEG test? What are the side effects?
SEEG is generally considered a safe test . However, like anything done on the brain, it can carry some risks. These include:
- Bleeding inside the brain (`(brain bleed / intracranial hemorrhage)`).
- Infection.
- It's like a stroke.
But don't worry, doctors are doing everything they can to minimize these risks.
How long does it take to recover after SEEG?
Your medical team will tell you when you will be fully recovered and able to resume normal activities. You will usually start to feel much better within 24 to 48 hours .
What results can be expected from a SEEG test?
The results of the SEEG test depend on what the medical team finds during the observation period. In most cases, the SEEG can pinpoint the exact location of the seizure. Specialists will carefully review the recordings of your brain activity and decide if you are eligible for surgery or other epilepsy treatments. Surgery to treat epilepsy is usually performed four to eight weeks after the SEEG, giving you time to recover.
When will the SEEG results be known?
You may receive some preliminary results before you leave the hospital. But before your treatment plan is finalized, you and your family will have time to discuss the final results with the medical team and make decisions.
Finally, I have to say... (Take-Home Message)
Living with epilepsy, a condition that can't be controlled with medication and starts in one part of the brain, can be a real challenge. You may be wondering what your options are.
SEEG is a safe and often successful surgical procedure that can pinpoint the exact location of your epilepsy in your brain.
This detailed information will help your specialists create the best treatment plan, which may include surgery. With effective treatment, your medical team can reduce your epilepsy symptoms and help you live a happy life again. So don't be afraid to talk to your doctor about this.
` Epilepsy, SEEG, Stereoelectroencephalography, Brain Surgery, Seizures, EEG, Epilepsy Treatment, Neurology
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