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Bipolar Coronal
Common
Average
Reference Referential
Point =
CAR
EEG scalp recording: normal, awake
Scalp EEG in TLE
Electrophysiological assessment
remains the corner stone for
assessment of patients with TLE.
Spikes (90%)
Cascino GD, et al. Routine EEG and temporal lobe epilepsy: relation to long-term
EEG monitoring, quantitative MRI, and operative outcome. Epilepsia 1996;37:651-6.
MRI in a patient with R mTLE:
Hippocampal volume loss & signal changes (short arrows)
Poor gray white differentiation in R M T gyrus (long arrow)
Routine Outpatient EEGs in TLE
Strong correlations for spikes and delta
may obviate the need for mandatory ictal
recordings in highly well selected
patients undergoing presurgical workup
with unilateral hippocampal atrophy on
MRI and congruent clinical and
neuropsychological data.
Cendes F, et al., Is ictal recording mandatory in temporal lobe epilepsy? Not when
the interictal electroencephalogram and hippocampal atrophy coincide. Arch Neurol.
2000;57:497-500.
Ictal EEGs in TLE
Ictal recordings are usually essential as some
patients can have concurrent non-epileptic
attacks such as psychogenic non-epileptic
seizures (PNESs).
Pfnder M, et al. Clinical features and EEG findings differentiating mesial from
neocortical temporal lobe epilepsy. Epileptic Disord 2002;4:189-95.
Hamer HM, et al. Interictal epileptiform discharges in temporal lobe epilepsy due to
hippocampal sclerosis versus medial temporal lobe tumors. Epilepsia 1999;40:1261-8.
mTLE vs nTLE
Mesial temporal IEDs occur infrequently in nTLE
but neocortical spikes is unlikely with mTLE.
IEDs in MTS tend to be more localized to anterior
temporal region but with increased tendency for
bilateral expression than mTLE secondary to
tumors.
Typical anterior temporal spikes can be seen in
association with extratemporal epilepsy (e.g.
mesial occipital lobe epilepsy which can mimic
TLE).
Pfnder M, et al. Clinical features and EEG findings differentiating mesial from
neocortical temporal lobe epilepsy. Epileptic Disord 2002;4:189-95.
Hamer HM, et al. Interictal epileptiform discharges in temporal lobe epilepsy due
to hippocampal sclerosis versus medial temporal lobe tumors. Epilepsia
1999;40:1261-8.
Aykut-Bingol C, et al. Surgical outcome in occipital lobe epilepsy: implications for
pathophysiology. Ann Neurol 1998;44:60-9.
Tandon N, et al. Occipital epilepsy: spatial categorization and surgical
management. J Neurosurg 2009;110:306-18.
Unilateral TLE
A portion of patients with unilateral TLE with
other evaluation parameters show bitemporal
IEDS.
How about Ebersole Type I and II. Ebersole JS, Wade PB. Spike voltage
identifies two types of frontotemporal epileptic foci. Neurology 1991;41:1425-33.
Prognostic Value of the Spike
Dipoles in TLE
How about Ebersole Type I and II. Ebersole JS, Wade PB. Spike voltage
identifies two types of frontotemporal epileptic foci. Neurology 1991;41:1425-33.
Spike Frequency in TLE
Frequent IEDs or high spike burden (i.e. 60
spikes/hour in one study) is associated with poor
outcome after temporal lobectomy (TLY).
Ebersole JS, Pacia SV.Localization of temporal lobe foci by ictal EEG patterns.
Epilepsia 1996;37:386-99.
An example of Ebersole Type II
Ictal Rhythm in TLE
Ebersole Type 3 Ictal Rhythms in TLE
neocortical seizures.
Ebersole JS, Pacia SV.Localization of temporal lobe foci by ictal EEG patterns.
Epilepsia 1996;37:386-99.
Simultaneous Scalp Ictal
Rhythms with Subdural and
Depth Recordings
Most subclinical electrical seizures
Siegel AM, et al. Medically intractable, localization-related epilepsy with normal MRI:
presurgical evaluation and surgical outcome in 43 patients. Epilepsia 2001;42:883-8.
Eisenschenk S, et al. Lateralization of temporal lobe foci: depth versus subdural electrodes.
Clin Neurophysiol 2001;112:836-44.
Subdurally Recorded Seizures
In general, most of the subdural seizures arise
from the same lobe showing predominant surface
IEDs and surface seizures.