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Objective <p>To evaluate the long-term efficacy and safety of stereo-electroencephalography (sEEG)-guided surgical resection in patients with MRI-negative, drug-resistant focal epilepsy and to identify predictors of favorable seizure outcomes.</p> Methods <p>We conducted a retrospective cohort study of 107 patients who underwent sEEG-guided resective epilepsy surgery at a tertiary neurosurgical center. The inclusion criteria were normal brain MRI (MRI-negative), drug-resistant focal epilepsy, and a minimum postoperative follow-up of one year.</p> Results <p>The temporal lobe was the most commonly resected site (66.2%), followed by the frontal lobe (24.8%). The mean postoperative follow-up period was 8.2 ± 7.0&#xa0;years. Complete seizure freedom (ILAE class 1) was achieved in 46.7% of the patients, and 54.2% had favorable outcomes (ILAE class 1 or 2). Clinical improvement was observed in 88.3% of patients, and reduction or discontinuation of antiseizure medications was observed in 61.7% of patients. Major complications (persistent motor deficits, disabling visual defects) occurred in 2.8% of cases. Neuropsychological function remained stable in 69.3%, improved in 14.9%, and worsened in 15.8% of patients. Quality of life improved significantly in 79.4% of the patients, and 70.1% resumed or maintained employment. A longer duration of sEEG monitoring was independently associated with seizure freedom (p = 0.008; OR, 1.2; <sub>95%</sub>CI [1.04–1.3]). Histopathological analysis revealed abnormal findings in 90% of the resected specimens.</p> Conclusion <p>sEEG-guided surgery in MRI-negative drug-resistant epilepsy provides substantial seizure control and significant improvements in quality of life, demonstrating a favorable risk–benefit ratio. Extended intracranial monitoring is a key predictor of surgical success.</p>

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Safety and efficacy of sEEG-guided resective surgery in patients with MRI-negative drug-resistant epilepsy

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Xavier Schumacher,
  • Valerio Frazzini,
  • Claude Adam,
  • Sophie Dupont,
  • Franck Bielle,
  • Alice Guesdon,
  • Marie Mere,
  • Vi-Huong Nguyen-Michel,
  • Vincent Navarro,
  • Bertrand Mathon

摘要

Objective

To evaluate the long-term efficacy and safety of stereo-electroencephalography (sEEG)-guided surgical resection in patients with MRI-negative, drug-resistant focal epilepsy and to identify predictors of favorable seizure outcomes.

Methods

We conducted a retrospective cohort study of 107 patients who underwent sEEG-guided resective epilepsy surgery at a tertiary neurosurgical center. The inclusion criteria were normal brain MRI (MRI-negative), drug-resistant focal epilepsy, and a minimum postoperative follow-up of one year.

Results

The temporal lobe was the most commonly resected site (66.2%), followed by the frontal lobe (24.8%). The mean postoperative follow-up period was 8.2 ± 7.0 years. Complete seizure freedom (ILAE class 1) was achieved in 46.7% of the patients, and 54.2% had favorable outcomes (ILAE class 1 or 2). Clinical improvement was observed in 88.3% of patients, and reduction or discontinuation of antiseizure medications was observed in 61.7% of patients. Major complications (persistent motor deficits, disabling visual defects) occurred in 2.8% of cases. Neuropsychological function remained stable in 69.3%, improved in 14.9%, and worsened in 15.8% of patients. Quality of life improved significantly in 79.4% of the patients, and 70.1% resumed or maintained employment. A longer duration of sEEG monitoring was independently associated with seizure freedom (p = 0.008; OR, 1.2; 95%CI [1.04–1.3]). Histopathological analysis revealed abnormal findings in 90% of the resected specimens.

Conclusion

sEEG-guided surgery in MRI-negative drug-resistant epilepsy provides substantial seizure control and significant improvements in quality of life, demonstrating a favorable risk–benefit ratio. Extended intracranial monitoring is a key predictor of surgical success.