Modern Aspects of Invasive Epilepsy Monitoring: Utility for Seizure Localization and Therapeutic Decision-Making

BACKGROUND: Children with drug-resistant epilepsy often require invasive monitoring to guide surgical interventions. SUMMARY: Both subdural monitoring and stereoelectroencephalography (sEEG) have benefits and limitations in identifying seizure onset and mapping brain function. sEEG allows for more anatomically diffuse sampling, including deep structures like the thalamus. Monitoring leads to a better understanding of epileptic networks and their proximity to eloquent cortex. This often guides the decision between resective/ablative therapies and neuromodulation. There is increasing interest in the use of thalamic stimulation in neuromodulation, although pediatric data are limited. KEY MESSAGE: The increase in invasive monitoring in the USA coupled with the emergence of additional surgical treatments offers new hope to children with refractory epilepsy.