Stereo-EEG around the world: State of the art in Italy

Abstract

Stereo-EEG is not just a diagnostic examination but a complex methodology, requiring an accurate synthesis of many data (anatomical, clinical, neurophysiological, cognitive, metabolic, and genetic). The implantation scheme is decided based on a hypothesis (or hypotheses) of epileptogenic zone localization. Subsequently, intracerebral electrical stimulation is used to define the extent of highly functional cortical regions and to reproduce the clinical symptoms and signs associated with seizures. Finally, stereo-EEG-guided thermocoagulation is used, with the dual purpose of stopping/reducing the seizures and determining the prognosis of possible resective (curative) surgery. The centers in Italy that use stereo-EEG derive from the French school of Bancaud and Talairach. Nevertheless, each one has interpreted, on the basis of its own specificity and talent, a new methodology and philosophy of implantation. The present work presents the state of the art of stereo-EEG use in Italy, with detail of the stereo-EEG program of the Munari center in Milano, as well as those of Florence, Bologna and Rome.

Keywords: Cortical stimulation; Epilepsy surgery; MR negative; Pre-surgical evaluation; Stereo-EEG.