The Role of SEEG After Failed Epilepsy Surgery: When, Why and How
Overview
Medically refractory epilepsy remains one of the most complex and debilitating neurological disorders to manage. While surgical resection can achieve long-term seizure control in 60–80% of patients with temporal lobe epilepsy and 40–60% with extratemporal epilepsy, a substantial number of patients continue to experience seizures following surgery. These post-surgical failures represent a uniquely challenging clinical population, where therapeutic options are limited, and decision-making becomes increasingly nuanced.
This course centers on the critical role of SEEG in the re-evaluation and management of patients with failed epilepsy surgery. Since seizure recurrence significantly diminishes quality of life and increases the risk of morbidity, mortality, cognitive decline, and psychosocial complications, identifying the best path forward for these patients is of paramount importance.
Through expert-led lectures, interactive case discussions, and immersive hands-on SEEG analysis workshops, this course aims to define the most effective, evidence-informed approaches to reassess and treat patients who have not achieved seizure freedom after an initial surgical attempt.
Participants will explore how to integrate multimodal data—including seizure semiology, neuroimaging, electrophysiology, neuropathology, and genetics—into a comprehensive diagnostic and therapeutic strategy. Particular emphasis will be placed on refining hypotheses for SEEG implantation, interpreting complex SEEG and cortical stimulation data, and determining when reoperation, neuromodulation, or alternative therapies may be most appropriate. Attendees will gain practical tools and clinical frameworks to support multidisciplinary decision-making and improve outcomes in this high-risk population.
Learning Objectives
Upon completion of this activity, participants will be able to:
- Define the clinical, anatomical, electrophysiological, and genetic mechanisms that may contribute to the failure of epilepsy surgery.
- Describe the role of SEEG in the diagnostic re-evaluation of patients with failed epilepsy surgery and its implications for treatment planning.
- Implement a multimodal approach—incorporating imaging, neurophysiology, semiology, and pathology—to reassess and localize seizure onset.
- Design individualized, comprehensive management plans for patients who are not candidates for traditional resective surgery.
Epilepsy Surgery Dissection Workshop
Workshop Overview
Epilepsy surgery offers hope to patients afflicted with drug resistant seizures and can lead to significant improvements in their quality of life, including seizure freedom. As many as one million patients are potential candidates for epilepsy surgery in the United States, and yet surgical volumes are not improving, implying that barriers continue to limit the adequate referral and surgical work-up of these patients. Moreover, with the majority of open surgical epilepsy procedures now focused to a smaller number of specialized centers, adequate training in the art of open techniques is becoming a lost skill
The goal of this course is to provide a hands-on educational forum for seasoned epilepsy neurosurgeons to interact with young neurosurgeons in-training and junior neurosurgery faculty. Basic anatomy, historical themes, detailed epilepsy surgery techniques and representative case presentations will be reviewed in both the classroom and laboratory setting. Indications regarding open resection versus neuromodulation will be emphasized. The topics of robotic stereotactic surgery, laser ablation, vagal nerve stimulation, responsive neurostimulation, deep brain stimulation and focused ultrasound will also be reviewed, spanning the armamentarium of innovative techniques available to the aspiring epilepsy neurosurgeon of the modern era.
The neurosurgical lab at Lutheran Hospital will be utilized to demonstrate and offer hands-on practice of core epilepsy surgical techniques using cadaveric anatomical specimens. Additionally, strategies for developing an epilepsy surgery practice, and inherent challenges to successful epilepsy surgery, will be highlighted. Ultimately, this course is dedicated to training the next generation of emerging surgical leaders in epilepsy, in a collaborative and collegial environment, to improve care for epilepsy patients around the country.
Learning Objectives
Upon completion of this activity, participants will be able to:
- Describe the surgical anatomy of the temporal lobe and how the underlying pathology relates to the choice of surgical technique.
- Summarize the overall outcomes from surgeries for treating patients with epilepsy.
- Demonstrate the basic surgical techniques necessary to complete a functional disconnection of the epileptic cerebral hemisphere.
- Discuss the complexity of identifying ictal onsets in cortical regions outside the temporal lobe and identify specific techniques that allow safe surgical resection in eloquent cortex areas.
- Debate the rationale and show the appropriate techniques for placement of intracerebral electrodes to prove a hypothesis of seizure onset based on individual patient characteristics.
- Demonstrate the techniques of and rationale for vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation therapies.
Target Audience
This course is designed for neurosurgeons, neurologists, neurophysiologists, fellows, physician assistants and nurse practitioners involved in the surgical treatment of epilepsy.