The main goal of curative epilepsy surgery is the arrest of the epileptic activity by the complete resection (or complete disconnection) of the cortical or subcortical areas responsible for the primary organization of the epileptogenic activity. As successful resective epilepsy surgery relies on accurate preoperative localization of the epileptogenic zone (EZ), a presurgical evaluation is fundamental to obtain the widest and most accurate spectrum of information from clinical, anatomical, and neurophysiological aspects. This chapter describes stereoelectroencephalography (SEEG) as a method of extraoperative brain exploration for medically refractory epilepsy. It outlines resective epilepsy surgery guided by SEEG and compares SEEG-guided resections in lesional and nonlesional scenarios. The main clinical challenge for the near future remains in the further refinement of specific selection criteria for the different methods of invasive monitoring, with the ultimate goal of comparing and validating the results (long-term seizure-free outcome) obtained from different methods of invasive monitoring.

Intracranial recordings, whether obtained with Stereo electroencephalography (SEEG), subdural grid (SDG), or SDG with depth electrodes, aid in identifying the epileptogenic zone and allow for delineation of appropriate surgical boundaries in patients with medically refractory epilepsy. Fundamentally, SEEG is different from SDG in that SEEG allows for three-dimensional cortical sampling whereas SDGs provide a two-dimensional neurophysiologic view. Beyond this, SEEG offers multiple benefits over SDG implantations. In appropriately selected patients, SEEG allows for delineation of the epileptogenic zone while avoiding the need for a craniotomy. In addition, SEEG provides recording from deep cortical structures and within cortical sulci. SEEG offers an opportunity for evaluating multiple potential regions, including bihemispheric areas. Given the benefits of SEEG with minimal risk associated with the procedure, SEEG should be considered in patients with medically refractory focal epilepsy and a potentially resectable epileptogenic zone.

Electroencephalography (EEG) activity recorded with intracranial electrodes shares many characteristics with scalp EEG. Thus, physiological rhythms of wakefulness and sleep recorded with scalp EEG are detected, such as alpha activity, mu rhythm, sleep spindles, or saw-tooth waves. These activities exhibit some local specificities in the intracranial EEG (ICEEG). This chapter provides a description of physiological activity throughout the sleep–wake cycle, regarding both spectral particularities and specific rhythms, inside and beyond the Berger frequency band. Intracranial recordings including investigation of mesio-temporal structures during sleep have provided evidence that within and across area coupling of sleep oscillations support cognitive functions of sleep. However, several fields remain incompletely explored, and could benefit from larger database analysis, which could allow overcoming the spatial sampling bias of SEEG, and translational approaches, especially regarding subcortical structures recordings in movement disorders, simultaneous multimodal explorations including functional imaging, and age-specific investigation of maturational aspects of sleep.

Interictal epileptiform discharges (IEDs) represent a distinct group of waveforms that are characteristically seen in people with epilepsy. Scalp detection of IEDs is based upon dipole localization and the surrounding field. The interictal electroencephalogram (EEG) plays a pivotal role in providing ancillary support for a clinical diagnosis of epilepsy. Abnormal focal IEDs on EEG represent a heightened predisposition for the expression of focal seizures. Epileptiform discharges appear in different morphologies. Both spikes and sharp waves are referred to as IEDs and are defined by their duration. Mid-temporal IEDs occur in patients with temporal lobe epilepsy. Benign childhood epilepsy with centrotemporal spikes is a common childhood genetic localization related epilepsy syndrome. Frontal spikes are often found in patients with frontal lobe epilepsy, although they may be absent in up to one-third of patients. Central IEDs can occur with symptomatic focal epilepsies at any age.

Psychiatric disorders are frequently encountered in movement disorders. They may precede and obscure or often exacerbate neurological symptoms. Psychiatric interviewing can be daunting for many non-psychiatrists, who are accustomed to a more structured, less intuitive approach to the examination. It is critical for every clinician to have the basic skills to assess psychiatric symptoms in order to screen for and measure the severity of emotional distress. Longitudinal monitoring of psychiatric problems assists in the treatment of the underlying neurological condition. Some psychiatric symptoms may emerge alongside motor symptoms in the course of neurodegenerative diseases, such as Parkinson or Huntington disease. The Mental Status Examination is a comprehensive evaluation of the current state of psychiatric functioning, based on the examiner’s observations and responses directly elicited from the patient.

Technological advancements in the field of radiology, combined with exponential growth in computational processing power, have allowed for innovative robotic applications in neurosurgery to assist with sophisticated surgical approaches such as depth electrode implantation. Robotic-assisted stereotactic techniques have contributed greatly to the remarkable surge in the adoption of stereoelectroencephalography (SEEG) in recent years. This chapter outlines each of the steps, including trajectory planning, registration to establish the stereotactic space, implantation of the anchor bolts and depth electrodes, and confirmation of accurate implantation with intraoperative computed tomography. Meticulous technique incorporating the robot leads to a safe and effective implantation and increases the chances for a seizure-free and deficit-free outcome. It serves as a blueprint for neurosurgeons eager to conduct robotic-assisted SEEG depth electrode placement with robotic stereotactic assistant. The chapter provides a comprehensive workflow using the robotic approach, from surgical planning and setup, to confirmation of electrode placement.

Patients with movement disorders can develop motor, cognitive, and behavioral impairments that can lead to a loss of functional ability and independence in activities of daily living resulting in decrease quality of life. Physical therapy can help to prevent and treat these symptoms. During the rehabilitation process, physical therapists assist patients to restore quality movement, functional mobility, and participation in work, family, and other social roles. The aim of therapy is to maximize independence and quality of life at the time of the diagnosis and throughout the course of the disorder. This chapter focuses on the role of physical therapists in the care and management of movement disorders. It first discusses the important role of exercise in the management of Parkinson disease. The chapter subsequently discusses the roles of physical therapists as part of a multidisciplinary team. Finally, it discusses the specific issue of falls in movement disorders.

Polysomnography (also called a sleep study) simultaneously and continuously records multiple different biophysiological parameters across a sleep period to characterize sleep, identify, and sometimes treat sleep disorders. The American Academy of Sleep Medicine (AASM) has published comprehensive evidence- and consensus-based guidelines of indications for polysomnography in adults and children. The AASM and the Centers for Medicare and Medicaid Services in the United States classify sleep studies into four categories (levels 1-4). This chapter distinguishes wakefulness, non-rapid eye movement, and rapid eye movement (REM) sleep in a poly-somnogram (PSG) by recording as few as three different biophysiological signals: electroencephalography, electrooculography, and chin electromyogram. The AASM Scoring Manual has multiple rules for when to start, continue, or stop scoring sequential epochs of REM sleep in a PSG. Respiratory events of interest in a PSG are apneas, hypopneas, respiratory effort-related arousals, Cheyne-Stokes respiration, periodic breathing, sleep-related hypoxemia, or hypoventilation.