The evolution of stereo-electroencephalography (SEEG) has transformed epilepsy treatment by offering deeper insights into seizure foci localization and seizure networks. As technology advances, recent breakthroughs continue to refine SEEG’s role in evaluating and managing drug-resistant epilepsy. These developments not only enhance clinical decision-making but also improve patient outcomes by guiding more precise surgical interventions.

Breakthroughs in SEEG Technology

In recent years, several advancements have emerged that contribute to the growing precision of SEEG:

• Integration with Advanced Imaging Modalities: Studies show that combining SEEG with imaging techniques such as MRI, FDG-PET, and MEG strengthens the localization of epileptogenic zones (EZs) (Grinenko et al., 2018) (Satzer et al., 2022) (Sukprakun, Tepmongkol, 2022). By using multimodal approaches, clinicians gain a more comprehensive understanding of seizure networks, leading to better surgical outcomes.
• High-Frequency Oscillations (HFOs) as Predictors of Seizure Onset: Research highlights the importance of fast ripples (250-500 Hz) and their role in identifying epileptogenic tissue. While traditional biomarkers like spikes and standard EEG readings have limitations in specificity, fast ripples have emerged as more reliable predictors of surgical success (Fabbri et al., 2025) (Schonberger et al., 2019).
• Interictal Biomarkers for SEEG-Guided Surgery: The co-occurrence of spikes and ripples (S+R) within SEEG recordings has demonstrated superior predictive accuracy in delineating the epileptogenic zone compared to spikes and ripples detected separately. (Fabbri et al., 2025). This has significant implications for refining surgical targeting and reducing unnecessary resections.
• Machine Learning for Epileptic Zone Identification: Advances in computational analysis are revolutionizing SEEG interpretation. Recent research has explored how artificial intelligence and machine learning models, trained on SEEG data, can improve epileptogenic zone identification. These models analyze spectral features of seizures and improve differentiation between primary seizure-generating areas and propagation zones (Grinenko et al., 2018).

These developments reinforce SEEG’s role as an indispensable tool for epilepsy surgery planning, ensuring that interventions are based on strong data rather than broad estimations.

The Role of SEEG in Modern Epilepsy Treatment

SEEG remains the gold standard for mapping seizure networks in patients with drug-resistant epilepsy. Unlike surface EEG, which is limited to cortical activity, SEEG provides three-dimensional depth recordings, allowing clinicians to:

• Pinpoint epileptogenic foci with high precision
• Differentiate between primary and propagated seizure activity
• Precisely map the brain to prepare for resection with the aim to preserve eloquent brain regions while maximizing seizure-free outcomes

Recent findings emphasize the role of fast gamma activity in identifying the epileptogenic zone. Studies indicate that a fingerprint of epileptogenic activity consists of sharp transients, high-frequency oscillations, and a suppression of lower frequencies at seizure onset (Grinenko et al., 2018). Recognizing these patterns in SEEG recordings allows for a more targeted surgical approach, minimizing unnecessary resections.

Looking Ahead: The Future of SEEG

The ongoing refinement of SEEG technology and its integration with AI-driven analytics, interictal biomarkers, and multimodal imaging are paving the way for a new era in epilepsy surgery. Future directions include:

• Real-time seizure prediction models using SEEG data to enable proactive interventions
• Personalized treatment plans based on biomarker-driven precision medicine
• Advances in minimally invasive SEEG electrode designs to improve patient safety and comfort

For medical professionals, staying updated on these advancements is crucial for optimizing treatment strategies. As the field of epilepsy surgery continues to evolve, SEEG remains at the forefront of innovation, driving better outcomes for patients worldwide.

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