Insights from multimodal Simultaneous SEEG-EEG and SEEG-MEG recordings: a case of combined, generalized and focal epilepsy

Aung, T., Cadet, K., Mayoglou, L., Aydin, U. ORCID: https://orcid.org/0000-0002-6327-7811, Niranjan, A. and Bagić, A. I. (2026) Insights from multimodal Simultaneous SEEG-EEG and SEEG-MEG recordings: a case of combined, generalized and focal epilepsy. Epilepsia. ISSN 0013-9580 doi: 10.1002/epi.70249

Abstract/Summary

Despite formal recognition of “combined generalized and focal epilepsy” in the 2017 ILAE classification, its implications for therapeutic decision-making remain ambiguous. We report a case demonstrating how focal cortical pathology can interact with distributed epileptic networks using multimodal electrophysiology. A patient with longstanding presumed generalized epilepsy and a left frontal malformation of cortical development (MCD) underwent multimodal evaluation with simultaneous scalp EEG-stereo-electroencephalography (SEEG; left frontal lesion-targeted implantation with a right frontal sentinel electrode), and simultaneous SEEG–magnetoencephalography (MEG). Simultaneous scalp EEG and SEEG demonstrated generalized spike–wave discharges (GSWs) with bilateral frontal and thalamic involvement, without focal interictal epileptiform activity at the lesion site. Direct cortical stimulation of SEEG contacts adjacent to the MCD reproduced habitual seizures, producing localized after-discharges followed by widespread thalamocortical engagement and delayed focal cortical evolution. Simultaneous SEEG–MEG recordings of GSWs revealed early posterior hemispheric involvement with subsequent frontal recruitment, supporting a distributed network mechanism. Left frontal MCD resection was associated with elimination of generalization, with persistent thalamic spike–wave activity recorded by a responsive neurostimulator that remained inactive for stimulation. Together, these findings demonstrate the limitations of fixed dichotomous focal-generalized distinctions and highlight the value of network-based approaches to epilepsy classification and surgical treatment

Item Type	Article
URI	https://centaur.reading.ac.uk/id/eprint/128885
Identification Number/DOI	10.1002/epi.70249
Refereed	Yes
Divisions	Interdisciplinary Research Centres (IDRCs) > Centre for Integrative Neuroscience and Neurodynamics (CINN) Interdisciplinary centres and themes > ASD (Autism Spectrum Disorders) Research Network Life Sciences > School of Psychology and Clinical Language Sciences > Ageing Life Sciences > School of Psychology and Clinical Language Sciences > Department of Psychology Life Sciences > School of Psychology and Clinical Language Sciences > Neuroscience
Publisher	Wiley-Blackwell
Download/View statistics	View download statistics for this item