Intracranial EEG substrates of scalp EEG interictal spikes.
ABSTRACT To determine the area of cortical generators of scalp EEG interictal spikes, such as those in the temporal lobe epilepsy.
We recorded simultaneously 26 channels of scalp EEG with subtemporal supplementary electrodes and 46 to 98 channels of intracranial EEG in 16 surgery candidates with temporal lobe epilepsy. Cerebral discharges with and without scalp EEG correlates were identified, and the area of cortical sources was estimated from the number of electrode contacts demonstrating concurrent depolarization.
We reviewed approximately 600 interictal spikes recorded with intracranial EEG. Only a very few of these cortical spikes were associated with scalp recognizable potentials; 90% of cortical spikes with a source area of >10 cm(2) produced scalp EEG spikes, whereas only 10% of cortical spikes having <10 cm(2) of source area produced scalp potentials. Intracranial spikes with <6 cm(2) of area were never associated with scalp EEG spikes.
Cerebral sources of scalp EEG spikes are larger than commonly thought. Synchronous or at least temporally overlapping activation of 10-20 cm(2) of gyral cortex is common. The attenuating property of the skull may actually serve a useful role in filtering out all but the most significant interictal discharges that can recruit substantial surrounding cortex.
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ABSTRACT: This paper considers the solution of the bioelectromagnetic inverse problem with particular emphasis on focal compact sources that are likely to arise in epileptic data. Two linear inverse methods are proposed and evaluated in simulations. The first method belongs to the class of distributed inverse solutions, capable of dealing with multiple simultaneously active sources. This solution is based on a Local Auto Regressive Average (LAURA) model. Since no assumption is made about the number of activated sources, this approach can be applied to data with multiple sources. The second method, EPIFOCUS, assumes that there is only a single focal source. However, in contrast to the single dipole model, it allows the source to have a spatial extent beyond a single point and avoids the non-linear optimization process required by dipole fitting. The performance of both methods is evaluated with synthetic data in noisy and noise free conditions. The simulation results demonstrate that LAURA and EPIFOCUS increase the number of sources retrieved with zero dipole localization error and produce lower maximum error and lower average error compared to Minimum Norm, Weighted Minimum Norm and Minimum Laplacian (LORETA). The results show that EPIFOCUS is a robust and powerful tool to localize focal sources. Alternatives to localize data generated by multiple sources are discussed. A companion paper (Lantz et al. 2001, this issue) illustrates the application of LAURA and EPIFOCUS to the analysis of interictal data in epileptic patients.Brain Topography 02/2001; 14(2):131-7. · 3.67 Impact Factor
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ABSTRACT: In evaluation of patients with complex partial seizures who are candidates for surgical treatment, exact definition of the epileptogenic focus is essential for a good surgical outcome. We report a new technique which permits detailed mapping of the epileptogenic activity in the basal temporal lobe and the convexity of the temporal lobe. The technique consists of placement of at least 16 basal temporal electrodes and an additional 64 electrodes covering the temporal convexity. This extensive coverage permits accurate definition of the limits of the epileptogenic focus and also of adjacent functional areas and therefore allows more significant determination than have previous techniques of the ideal extent of the surgical resection. This accuracy cannot be achieved with depth electrodes or the limited coverage provided by previously reported epidural or subdural electrode techniques.Epilepsia 30(2):131-42. · 3.91 Impact Factor
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ABSTRACT: To determine the value of scalp epileptiform EEG data and subdural interictal spikes in localizing temporal epileptogenesis among patients requiring invasive recordings. For this delineation, we related such factors to site of subdural seizure origin in 27 consecutive patients. Patients with temporal lobe epilepsy whose non-invasive lateralizing data were inconclusive and therefore required subdural electroencephalography were studied. All patients had (a) 24-h scalp telemetered EEGs, (b) adequate bitemporal subdural placements with an inferomesial line extending from a posterior burr hole anteriorly to <2.5 cm from anterior uncus and a lateral line reaching within 2.5 cm of the temporal tip, and (c) > or =2 subdurally recorded seizures. Three hundred one (96%) of 314 subdurally recorded clinical seizures involving all 27 patients arose from a discrete focus; 266 (85%) arose from mesial temporal regions, which was the origin of the majority of seizures in 24 (89%) patients. The majority of subdural seizures arose ipsilateral to the majority of scalp EEG spikes in 22 (81%) of 27, and most subdural seizures of 15 (75%) of 20 arose ipsilateral to scalp seizures. Lateralization of interictal subdural spikes correlated with that of subdural seizures in 74-92% of patients, depending on the method of spike compilation: for example, most subdural seizures arose from the same lobe of most consistent principal temporal spikes in 92% of patients. These indices of epileptogenesis also appeared more commonly on the side of effective (> or =90% improvement) temporal lobectomy than contralaterally in the following proportions: most consistent principal subdural spikes, 86% of patients ipsilateral vs. 9% contralateral; scalp-recorded clinical seizures, 55% vs. 18%; scalp EEG spikes, 45% vs. 9%. Even among patients whose scalp data are sufficiently complex to require invasive recording for clarification, lateralization of temporal scalp interictal and ictal epileptiform activity and subdural interictal spikes should be included when assessing the side of temporal epileptogenesis.Epilepsia 05/2001; 42(4):508-14. · 3.91 Impact Factor