Our Summary

This research paper talks about the intracranial electroencephalogram (iEEG), a tool that is important in making decisions about epilepsy surgery. iEEG has been used to locate the areas of the brain causing epilepsy for over 70 years, and it’s considered the best standard when deciding whether surgery is needed. However, there are no clear guidelines to distinguish between normal brain activity and actual epileptic activity in the results of iEEG.

The study reviews the current understanding and knowledge about iEEG. It looks at normal results and variations, how sleep can affect iEEG results, patterns of activity during and between seizures, and how all these relate to known causes of epilepsy and the outcomes of surgery. The goal is to improve the use of iEEG in diagnosing and treating epilepsy.

FAQs

  1. What is the role of the intracranial electroencephalogram (iEEG) in epilepsy surgery?
  2. Are there established guidelines for distinguishing between normal brain activity and genuine iEEG epileptic activity?
  3. What is the impact of sleep on regional and lobar iEEG?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative and post-operative instructions carefully. This may include avoiding certain medications, fasting before surgery, and following rehabilitation protocols. It is important to communicate any concerns or questions with your healthcare team to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for brain surgery include those with epilepsy that is not well controlled with medication, brain tumors, arteriovenous malformations, traumatic brain injuries, and certain movement disorders such as Parkinson’s disease. The intracranial electroencephalogram (iEEG) is essential in decision making for epilepsy surgery, as it helps to localize epileptogenic brain regions and determine the best course of treatment. Established guidelines for what constitutes genuine iEEG epileptic activity and what is normal brain activity are not available, but ongoing research is helping to improve understanding of these patterns and their relation to surgical outcomes.

Timeline

Before brain surgery:

  • Patient undergoes consultation with a neurosurgeon and epileptologist to discuss treatment options
  • Patient undergoes pre-surgical evaluations including imaging studies, neuropsychological testing, and electroencephalogram (EEG) monitoring
  • Based on results of evaluations, patient may be deemed a candidate for brain surgery
  • Patient undergoes placement of intracranial electroencephalogram (iEEG) electrodes to localize epileptogenic brain regions

After brain surgery:

  • Patient undergoes brain surgery to remove the epileptogenic brain tissue
  • Patient is closely monitored in the intensive care unit post-surgery
  • Patient may experience side effects such as headaches, fatigue, and cognitive difficulties
  • Patient undergoes follow-up appointments with the neurosurgeon and epileptologist to monitor recovery and adjust medication as needed
  • Patient undergoes post-surgical evaluations to assess surgical outcome and determine long-term seizure control.

What to Ask Your Doctor

Some questions a patient should ask their doctor about brain surgery include:

  1. What specific type of brain surgery is being recommended for my condition?
  2. What are the risks and potential complications associated with the surgery?
  3. How long will the recovery process be, and what can I expect during the recovery period?
  4. What are the expected outcomes of the surgery in terms of improving my condition?
  5. Will I need additional treatments or therapies following the surgery?
  6. What is the success rate of this type of surgery for my particular condition?
  7. Are there any alternative treatment options available that I should consider?
  8. How many times have you performed this type of surgery, and what is your success rate?
  9. How long will I need to stay in the hospital after the surgery?
  10. What can I do to prepare for the surgery and optimize my chances of a successful outcome?

Reference

Authors: Kokkinos V. Journal: Neurosurg Clin N Am. 2020 Jul;31(3):421-433. doi: 10.1016/j.nec.2020.03.007. Epub 2020 Apr 25. PMID: 32475490