Postictal self-removal of intracerebral electrodes during stereoelectroencephalography monitoring: A case series.

Epilepsy surgery remains the most effective treatment for focal drug-resistant epilepsy, and stereoelectroencephalography (SEEG) is increasingly used to define the epileptogenic-zone network (EZN) and guide curative or palliative interventions. While SEEG is considered a safe invasive procedure, adverse events arising during monitoring itself are rarely described. We report three exceptional cases of postictal self-removal of intracerebral electrodes during SEEG monitoring. Among 591 implanted patients between January 2000 and October 2025 at Timone Hospital, Marseille, three patients (0.5%) met the inclusion criteria. All were young right-handed men with normal neurocognitive development, focal drug-resistant epilepsy and no psychiatric comorbidity. Self-removal occurred during the postictal phase of spontaneous seizures-two following focal-to-bilateral tonic-clonic seizures and one after a focal impaired-awareness seizure-on the second day of monitoring under complete or partial antiseizure medication withdrawal. Postictal behavior was characterized by agitation, wandering, and, in two cases, resistive aggression when nursing staff attempted to intervene. None of the patients sustained neurological sequelae or significant cerebrovascular complications. EZN involved the temporal lobe in all cases. These observations illustrate that postictal confusion, particularly under medication withdrawal, may occasionally manifest as resistive behavior capable of causing self-harm by means of device manipulation. Awareness of this rare, but potentially hazardous phenomenon, identification of at-risk patients, and implementation of tailored preventive measures may help improve the safety of invasive epilepsy monitoring.