Intraoperative electrocorticography in focal drug‑resistant epilepsy: A 10‑year retrospective single‑center study

Intraoperative electrocorticography (ECoG) represents a crucial tool for improving seizure outcomes during epilepsy surgeries by assisting in localization of the epileptogenic zones. There is a shortage of information in the literature regarding single‑center experiences and long‑term outcomes after ECoG‑guided surgeries. Data are particularly scarce from the Eastern Mediterranean Region. The aim of the present retrospective study was to investigate the effectiveness of ECoG‑guided epilepsy surgeries performed in a single center in terms of seizure outcomes. The study included 30 patients with drug‑resistant epilepsy who underwent ECoG‑guided surgeries between January 2013 and December 2024. Participant details, clinical history and data, surgical interventions, and outcomes were all reviewed retrospectively. The intraoperative findings were assessed and post‑resection ECoG was used to define the extent of resections. Of the 30 patients, 19 (63.3%) achieved complete seizure freedom (Engel Class I) post‑surgery. ECoG revealed zones of preexisting epileptogenic activity in all patients undergoing the procedure, with 43.3% of patients showing no residual interictal discharges on ECoG after resection. ECoG remains relevant in achieving improved outcomes in epilepsy surgery, with seizure freedom accurately predicted by post‑surgical ECoG silence.