Stereoelectroencephalography for Epilepsy Presurgical Assessment

Background and Objectives: Stereoelectroencephalography (SEEG) is increasingly used worldwide for epilepsy presurgical evaluation. A data-driven view of SEEG practice evolution is lacking for any world region. We aimed to perform a nationwide survey of SEEG use in Australian adult epilepsy centers. We predicted that the proportion of nonlesional MRI cases, number of electrodes, and radiofrequency thermocoagulation (RF-TC) use would increase over time. Methods: All epilepsy centers in Australia undertaking SEEG in patients older than 16 years at any time were invited to participate in a nationwide survey. Data were retrospectively and/or prospectively collected on patient demographics and SEEG exploration. Descriptive statistics were used. RF-TC use differed between centers and evolved, with a crossover to the majority use of RF-TC occurring 5 years after regulatory approval. Discussion: This comprehensive nationwide and regional survey of SEEG practice comprises full ascertainment of all centers and allows analysis of changes in practice over time. Whole cohort results show a high proportion of nonlesional MRI cases achieving satisfactory surgical outcomes and evolution to increased RF-TC use. Indigenous access to SEEG seems to be lower than expected, consistent with broader health care access issues for this population group. Nationwide collaboration on SEEG data provides a basis for analysis of practice at the individual center and state and national levels to optimize health care planning and sharing of expertise.