Inside Seizures: How StereoEEG is Transforming Epilepsy Care

Epilepsy is a disorder of the brain, characterized by the occurrence of seizures (sudden bursts of abnormal electrical activity that can be either localized in one area of the brain or generalized). They disrupt the brain’s normal function, impairing movement, awareness, speech, and/or sensation.

Even when epilepsy is correctly diagnosed and treated, some people continue to have seizures despite appropriate therapy. Many external factors—such as missed doses of medication, sleep deprivation, stress, or alcohol use—can lower seizure threshold and make seizures more likely, but these do not fully explain why some patients remain uncontrolled.

Drug-resistant (refractory) epilepsy is defined as the failure to achieve sustained seizure freedom despite adequate trials of at least two appropriately chosen and tolerated antiseizure medications (either as single drugs or in combination). This resistance may arise from various mechanisms, including genetic influences, abnormal brain networks that generate seizures from multiple regions, or biological barriers that limit the penetration of drugs into the brain.

Patients with drug-resistant epilepsy require a comprehensive evaluation at a specialized epilepsy center to consider additional options such as epilepsy surgery, neurostimulation (e.g., VNS, RNS, DBS), or dietary and other advanced therapies. Early recognition and referral are crucial to enhancing outcomes and improving quality of life.

For patients with drug-resistant epilepsy, SEEG is a critical next step in exploring the precise brain regions where seizures originate, allowing for accurate mapping of epileptic networks.

“The goal of SEEG is to map exactly where seizures are coming from,” Dr. Pucci said. “In 90–95% of cases, we can map exactly where the seizures are located and also ensure that this area does not overlap with functionally critical brain areas.”

The procedure is a minimally invasive procedure, assisted by a precise surgical robot. Neurosurgeons place thin wires, called electrodes, directly into the brain through a burr hole small 2-millimeter hole. These electrodes record seizure activity and allow us to map critical neurological functions, such as language

Thanks to SEEG, it is possible to precisely localize the seizure onset zone in most patients, offering patient-specific surgical treatment options. “After determining the exact location, we may then implement personalized surgical intervention with the goal of eliminating or reducing seizures, minimally invasive laser ablation, neuromodulation, or removal of the tissue that is responsible for seizures,” Dr. Pucci said. “This allows us to treat the condition while also safely preserving the healthy parts of the brain responsible for language, movement, and sensory functions, memory, and cognition.”

Unlike traditional surface scalp EEG, which measures electrical activity only at the brain’s surface, SEEG enables accurate recording from the brain itself, providing 3-D data that offers a far more detailed representation of seizure propagation and networks.

One of the major advantages of SEEG is its minimally invasive surgical procedure, , with a very low rate of major adverse events. By offering a safer alternative method compared to craniotomy procedures, where parts of the skull are removed, SEEG leads to fewer complications. As a result, patients typically experience faster recovery times, shorter hospital stays, and a quicker return to normal activities compared to more invasive techniques.

SEEG provides the foundation for targeted interventions that have the potential to play a tremendous role, and in most cases, eliminate seizure activity.

“We have developed a comprehensive epilepsy surgery program to make potentially life-altering therapies available to our patients, who in years past may have otherwise had access,” stated Dr. Pucci.

This work is made possible by a multidisciplinary team of specialists, including epileptologists, neurosurgeons, neuropsychologists, neuroradiologists, and highly trained technicians. The program is dedicated to combining deep expertise with close collaboration to create individualized treatment plans and advanced procedures for patients with epilepsy, including those with drug-resistant forms. It is this approach that allows the team to never turn away patients who have exhausted other treatment options.

UIC’s access to advanced imaging, monitoring systems, robotic-assisted technology, and clinical expertise offers patients a clearer, more accurate diagnosis while safely exploring complex neurological conditions while minimizing risk.

“We are currently one of the highest volume SEEG centers in Chicago and growing. More importantly, our comprehensive team brings the highest expertise and commitment to our patients,” said Dr. Pucci.

If you or someone you know is seeking treatment or a second opinion, we have options.

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