The Lateralization of Ictal Scalp EEG in Focal Epilepsy_Journal of Epilepsy

Authors：

JIN Yang ¹ , ZHANG Wei ² , XU Bin ³ , HU Xiangshu ¹ ,  LIU Xingzhou ²

1. Epilepsy centre, Guangdong Sanjiu Brain Hospital, Guangzhou 510510, China;
2. Epilepsy centre, Shanghai Deji Hospital, Shanghai 200333, China;
3. Department of Neurology, Beijing Fuxing Hospital, Beijing 100045, China;

Corresponding author：

LIU Xingzhou, Email: sinclair_liu_vip@163.com

Keywords：

Ictal; Scalp EEG; Lateralization focal epilepsy; Diagnosis

DOI：

10.7507/2096-0247.20190069

Video：

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Objective To investigate the lateralization of ictal scalp EEG in different times in focal epilepsy.Methods 356 surface ictal EEG of 41 patients were reviewed retrospectively in focal epilepsy arising from the mesial frontal, lateralfrontal, mesialtemporal, neocorticaltemporal, insular lobes and posterior cortex from July, 2010 to at, 2016. Each ictal scalp EEG was subdivided into ten epoches (E1-E10), then the lateralization of every epoch was analyzed. Ten epochs EEG were merged into three timesas E1-E3, E4-E6 and E7-E10. The ratio of lateralization, mislateralization and non-lateralization of each timeEEG were studied. Ictal onset zone (IOZ) were precise localized by intracranial EEG. The results of epileptogenic zone corresponded with surgical outcomes as seizure free or decreased.Results 62% seizures were lateralized by surface ictal EEG in all epilepsies. Lateralized ictal scalp EEG were seen in nearly 80% of seizures in all times in temporal lobe epilepsy (TLE). The highest lateralization of 89% occurred inE4-E6 andfalse lateralization up to 30% in E1-E3 in mesial temporal lobe epilepsy (MTLE), whereas 95% lateralized seizures emerged in E1-E3 in neocortical temporal lobe epilepsy (NTLE). Apparent non-lateralization in all times were higher than lateralization in frontal lobe epilepsy (FLE), especially in mesial frontal lobe epilepsy (MFLE). Lateralization in E1-E3 was only 24% higher than other times. In addition, False lateralization never occurred in all times in lateral frontal lobe epilepsy (LFLE). There were maximum of 83%lateralized seizures in E1-E3 in LFLE and 93% in E1-E3 in posterior cortex epilepsy (PCE). Seizures arising from insular lobe epilepsy (ILE) tendedto predict less lateralization in all times.Conclusions Ictal scalp EEG of E1-E3 are valuable in the lateralization in all epilepsies particularly in LFLE, NTLE and PCE. Lateralized E4-E6 and E7-10 are very useful in MTLE.

Citation： JIN Yang, ZHANG Wei, XU Bin, HU Xiangshu, LIU Xingzhou. The Lateralization of Ictal Scalp EEG in Focal Epilepsy. Journal of Epilepsy, 2019, 5(6): 431-439. doi: 10.7507/2096-0247.20190069 Copy

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2.	Adamolekun B, Afra P, Boop FA. False lateralization of seizure onset by scalp EEG in neocortical temporal lobe epilepsy. Seizure, 2011, 20(6): 494-499.
3.	Kagawa K, Iida K, Katagiri M, et al. Successful treatment of mesial temporal lobe epilepsy with bilateral hippocampal atrophy and false temporal scalp ictal onset: a case report. Hiroshima J Med Sci, 2012, 61(2): 37-41.
4.	Napolitano CE, Orriols M. Two types of remote propagation in mesial temporal epilepsy: analysis with scalp ictal EEG. J Clin Neurophysiol, 2008, 25(2): 69-76.
5.	Spencer SS, Spencer DD. Implications of seizure termination location in temporal lobe epilepsy. Epilepsia, 1996, 37(5): 455-458.
6.	Sirin NG, Gurses C, Bebek N, et al. A quadruple examination of ictal EEG patterns in mesial temporal lobe epilepsy with hippocampal sclerosis: onset, propagation, later significant pattern, and termination. J Clin Neurophysiol, 2013, 30(4): 329-338.
7.	Javidan M. Electroencephalography in mesial temporal lobe epilepsy: a review. Epilepsy Res Treat, 2012, 9: 637430.
8.	Foldvary N, Klem G, Hammel J, et al. The localizing value of ictal EEG in focal epilepsy. Neurology, 2001, 57(11): 2022-2028.
9.	Schulz R, Lüders HO, Hoppe M, et al. Interictal EEG and ictal scalp EEG propagation are highly predictive of surgical outcome in mesial temporal lobe epilepsy. Epilepsia, 2000, 41(5): 564-570.
10.	Adam C, Hasboun D, Clemenceau S, et al. Fast contralateral propagation of after-discharges induced by stimulation of medial temporal lobe. J Clin Neurophysiol, 2004, 21(6): 399-403.
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14.	Caboclo LO, Garzon E, Oliveira PA, et al. Correlation between temporal pole MRI abnormalities and surface ictal EEG patterns in patients with unilateral mesial temporal lobe epilepsy. Seizure, 2007, 16(1): 8-16.
15.	Giagante B, Oddo S, Silva W, et al. Clinical-electroencephalogram patterns at seizure onset in patients with hippocampal sclerosis. Clin Neurophysiol, 2003, 114(12): 2286-2293.
16.	Sammaritano M, de Lotbinière A, Andermann F, et al. False lateralization by surface EEG of seizure onset in patients with temporal lobe epilepsy and gross focal cerebral lesions. Ann Neurol, 1987, 21(4): 361-369.
17.	Tezer FI, Dericioglu N, Bozkurt G, et al. Epilepsy surgery in patients with unilateral mesial temporal sclerosis and contralateral scalp ictal onset. Turk Neurosurg, 2011, 21(4): 549-554.
18.	Ebersole JS, Pacia SV. Localization of temporal lobe foci by ictal EEG patterns. Epilepsia, 1996, 37(4): 386-399.
19.	Azar NJ, Lagrange AH, Abou-Khalil BW. Transitional sharp waves at ictal onset−a neocortical ictal pattern. Clin Neurophysiol, 2009, 120(4): 665-672.
20.	Baumgartner C. Presurgical diagnosis of epilepsy and surgical epilepsy treatment. Wien KlinWochenschr, 1997, 109(6): 180-191.
21.	Bonelli SB, Lurger S, Zimprich F, et al. Clinical seizure lateralization in frontal lobe epilepsy. Epilepsia, 2007, 48(3): 517-523.
22.	Provini, F., et al Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain, 1999, 122(Pt 6): 1017-31.
23.	Nobili L, Francione S, Mai R, et al. Nocturnal frontal lobe epilepsy: intracerebral recordings of paroxysmal motor attacks with increasing complexity. Sleep, 2003, 26(7): 883-886.
24.	Bautista RE, Spencer DD, Spencer SS. EEG findings in frontal lobe epilepsies. Neurology, 1998, 50(6): 1765-1771.
25.	Jobst BC, Williamson PD. Frontal lobe seizures. Psychiatr Clin North Am, 2005, 28(3): 635-651.
26.	Yu T, Wang Y, Zhang G, et al. Posterior cortex epilepsy: diagnostic considerations and surgical outcome. Seizure, 2009, 18(4): 288-292.
27.	Jobst BC. Intractable occipital lobe epilepsy: clinical characteristics and surgical treatment. Epilepsia, 2010, 51(11): 2334-1337.
28.	Blume WT, Wiebe S, Tapsell LM. Occipital epilepsy: lateral versus mesial. Brain, 2005, 128(Pt 5): 1209-1225.
29.	梅珊珊. 岛叶癫痫的头皮脑电图和皮层脑电图对比分析. 第五届CAAE国际癫痫论坛, 2013: 1.
30.	Giulioni M, Marucci G, Martinoni M, et al. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg, 2013, 119(1): 37-47.
31.	Fauser S. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia, 2015, 56(1): 66-76.
32.	Varotto G, Tassi L, Franceschetti S, et al. Epileptogenic networks of type II focal cortical dysplasia: a stereo-EEG study. Neuroimage, 2012, 61(3): 591-598.
33.	Jeha LE, Najm I, Bingaman W, et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain, 2007, 130(Pt 2): 574-584.
34.	Simasathien T, Vadera S, Najm I, et al. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol, 2013, 73(5): 646-654.

1. 王玉平. 脑电图检查在癫痫诊断中的应用. 诊断学理论与实践, 2004, (2): 73-76.
2. Adamolekun B, Afra P, Boop FA. False lateralization of seizure onset by scalp EEG in neocortical temporal lobe epilepsy. Seizure, 2011, 20(6): 494-499.
3. Kagawa K, Iida K, Katagiri M, et al. Successful treatment of mesial temporal lobe epilepsy with bilateral hippocampal atrophy and false temporal scalp ictal onset: a case report. Hiroshima J Med Sci, 2012, 61(2): 37-41.
4. Napolitano CE, Orriols M. Two types of remote propagation in mesial temporal epilepsy: analysis with scalp ictal EEG. J Clin Neurophysiol, 2008, 25(2): 69-76.
5. Spencer SS, Spencer DD. Implications of seizure termination location in temporal lobe epilepsy. Epilepsia, 1996, 37(5): 455-458.
6. Sirin NG, Gurses C, Bebek N, et al. A quadruple examination of ictal EEG patterns in mesial temporal lobe epilepsy with hippocampal sclerosis: onset, propagation, later significant pattern, and termination. J Clin Neurophysiol, 2013, 30(4): 329-338.
7. Javidan M. Electroencephalography in mesial temporal lobe epilepsy: a review. Epilepsy Res Treat, 2012, 9: 637430.
8. Foldvary N, Klem G, Hammel J, et al. The localizing value of ictal EEG in focal epilepsy. Neurology, 2001, 57(11): 2022-2028.
9. Schulz R, Lüders HO, Hoppe M, et al. Interictal EEG and ictal scalp EEG propagation are highly predictive of surgical outcome in mesial temporal lobe epilepsy. Epilepsia, 2000, 41(5): 564-570.
10. Adam C, Hasboun D, Clemenceau S, et al. Fast contralateral propagation of after-discharges induced by stimulation of medial temporal lobe. J Clin Neurophysiol, 2004, 21(6): 399-403.
11. Napolitano CE, Orriols MA. Graduated and sequential propagation in mesial temporal epilepsy: analysis with scalp ictal EEG. J Clin Neurophysiol, 2010, 27(4): 285-291.
12. Wieser HG, ILAE Commission on Neurosurgery of Epilepsy. ILAE Commission Report. Mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia, 2004, 45(6): 695-714.
13. Serles W, Caramanos Z, Lindinger G, et al. Combining ictal surface-electroencephalography and seizure semiology improves patient lateralization in temporal lobe epilepsy. Epilepsia, 2000, 41(12): 1567-1573.
14. Caboclo LO, Garzon E, Oliveira PA, et al. Correlation between temporal pole MRI abnormalities and surface ictal EEG patterns in patients with unilateral mesial temporal lobe epilepsy. Seizure, 2007, 16(1): 8-16.
15. Giagante B, Oddo S, Silva W, et al. Clinical-electroencephalogram patterns at seizure onset in patients with hippocampal sclerosis. Clin Neurophysiol, 2003, 114(12): 2286-2293.
16. Sammaritano M, de Lotbinière A, Andermann F, et al. False lateralization by surface EEG of seizure onset in patients with temporal lobe epilepsy and gross focal cerebral lesions. Ann Neurol, 1987, 21(4): 361-369.
17. Tezer FI, Dericioglu N, Bozkurt G, et al. Epilepsy surgery in patients with unilateral mesial temporal sclerosis and contralateral scalp ictal onset. Turk Neurosurg, 2011, 21(4): 549-554.
18. Ebersole JS, Pacia SV. Localization of temporal lobe foci by ictal EEG patterns. Epilepsia, 1996, 37(4): 386-399.
19. Azar NJ, Lagrange AH, Abou-Khalil BW. Transitional sharp waves at ictal onset−a neocortical ictal pattern. Clin Neurophysiol, 2009, 120(4): 665-672.
20. Baumgartner C. Presurgical diagnosis of epilepsy and surgical epilepsy treatment. Wien KlinWochenschr, 1997, 109(6): 180-191.
21. Bonelli SB, Lurger S, Zimprich F, et al. Clinical seizure lateralization in frontal lobe epilepsy. Epilepsia, 2007, 48(3): 517-523.
22. Provini, F., et al Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain, 1999, 122(Pt 6): 1017-31.
23. Nobili L, Francione S, Mai R, et al. Nocturnal frontal lobe epilepsy: intracerebral recordings of paroxysmal motor attacks with increasing complexity. Sleep, 2003, 26(7): 883-886.
24. Bautista RE, Spencer DD, Spencer SS. EEG findings in frontal lobe epilepsies. Neurology, 1998, 50(6): 1765-1771.
25. Jobst BC, Williamson PD. Frontal lobe seizures. Psychiatr Clin North Am, 2005, 28(3): 635-651.
26. Yu T, Wang Y, Zhang G, et al. Posterior cortex epilepsy: diagnostic considerations and surgical outcome. Seizure, 2009, 18(4): 288-292.
27. Jobst BC. Intractable occipital lobe epilepsy: clinical characteristics and surgical treatment. Epilepsia, 2010, 51(11): 2334-1337.
28. Blume WT, Wiebe S, Tapsell LM. Occipital epilepsy: lateral versus mesial. Brain, 2005, 128(Pt 5): 1209-1225.
29. 梅珊珊. 岛叶癫痫的头皮脑电图和皮层脑电图对比分析. 第五届CAAE国际癫痫论坛, 2013: 1.
30. Giulioni M, Marucci G, Martinoni M, et al. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg, 2013, 119(1): 37-47.
31. Fauser S. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia, 2015, 56(1): 66-76.
32. Varotto G, Tassi L, Franceschetti S, et al. Epileptogenic networks of type II focal cortical dysplasia: a stereo-EEG study. Neuroimage, 2012, 61(3): 591-598.
33. Jeha LE, Najm I, Bingaman W, et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain, 2007, 130(Pt 2): 574-584.
34. Simasathien T, Vadera S, Najm I, et al. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol, 2013, 73(5): 646-654.

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The Lateralization of Ictal Scalp EEG in Focal Epilepsy

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