15 Subdural Grid Placement
15.1 Symptoms and Signs
Seizures
Temporary confusion
Staring spell
Loss of consciousness/awareness
Fear, anxiety, or deja vu
15.2 Surgical Pathology
Cranial benign/malignant neurological disorder
Cranial benign/malignant trauma
Cranial benign/malignant developmental disorder
15.3 Diagnostic Modalities
Physical examination
Neurological examination
Blood test
Electroencephalogram (EEG) of brain
High-density EEG of brain
PET scan of brain
CT scan of brain
MRI of brain
Functional MRI (fMRI) of brain
Statistical parametric mapping (SPM) of brain
Curry analysis
Magnetoencephalography (MEG) of brain
Single photon emission computed tomography (SPECT) of brain
Grid and strip electrode placement
Strips: 1 × 4 to 2 × 8 electrodes
Grids: 4 × 4 to 8 × 8 electrodes (16 to 64 contacts, respectively)
Contacts typically spaced 5 to 10 mm apart
15.4 Differential Diagnosis
Generalized seizure
Absence seizure (petit mal; brief loss of awareness)
Tonic seizure (muscle stiffening, falling)
Atonic seizure (loss of muscle control, collapse)
Clonic seizure (repeated jerking muscle movements)
Myoclonic seizure (sudden brief jerks of arms and legs)
Tonic-clonic seizure (grand mal; abrupt loss of consciousness, body stiffening and shaking, loss of bladder control, biting of tongue)
Focal seizure
Without loss of consciousness (alter emotions or change perception of environment, involuntary jerking of body part, spontaneous sensory tingling, dizziness, and flashing lights)
With impaired awareness (staring into space, performing repetitive movements like hand rubbing or walking in circles)
15.5 Treatment Options
Antiepileptic medication
Therapy and rehabilitation
Physiatry
Occupational therapy
Physical therapy
Speech pathology
Neuropsychology
Rehabilitation nursing
Recreational therapy
Vagus nerve stimulation
Ketogenic diet
If symptomatic and no improvement after nonoperative management:
Epilepsy surgery
Deep brain stimulation (implanting electrodes in brain to regulate abnormal impulses and brain activity)
Amount of stimulation controlled by pacemaker-like device under skin in upper chest (a subcutaneous wire connects this device to electrodes in brain)