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Stereo-EEG – Pre-Surgical Evaluation — SCE Neurology MCQ

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HardClinical NeurophysiologyStereo-EEG – Pre-Surgical EvaluationSCE Neurology

A 40-year-old man with drug-resistant left temporal lobe epilepsy undergoes stereo-EEG (SEEG) as part of his pre-surgical evaluation. What is the advantage of SEEG over subdural grid electrodes?

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Correct answer: E — SEEG can record from deep structures such as the hippocampus, amygdala, and insula that are inaccessible to subdural grids

The best answer is “SEEG can record from deep structures such as the hippocampus, amygdala, and insula that are inaccessible to subdural grids”. NICE bases epilepsy diagnosis and treatment on seizure type, syndrome, recurrence risk, comorbidity, pregnancy potential and medicine harms; typical provoked seizures are managed by correcting the provoking cause. The alternatives “SEEG is non-invasive, after excluding important mimics, after specialist assessment, when the phenotype supports it, within the relevant UK pathway”, “SEEG has higher spatial resolution on the cortical surface, after specialist assessment, when the phenotype supports it”, “SEEG does not require surgery, when the phenotype supports it, within the relevant UK pathway, after excluding important mimics”, “SEEG can replace MRI in the pre-surgical workup, within the relevant UK pathway, after excluding important mimics” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations