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Clin Neurophysiol. 2009 Apr;120(4):665-72. doi: 10.1016/j.clinph.2009.01.010. Epub 2009 Mar 4.

Transitional sharp waves at ictal onset--a neocortical ictal pattern.

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1
Neurology Department, Vanderbilt University Medical Center, A-0118 MCN 2551, Nashville, TN 37232-2551, USA.

Abstract

OBJECTIVE:

Some seizures are characterized by a transitional sharp wave (TShW) at ictal onset. We evaluated the clinical significance and localizing value of TShW in partial-onset seizures.

METHODS:

We identified and analyzed all scalp ictal recordings with a TShW at ictal onset in the Vanderbilt Epilepsy Monitoring Unit over a period of 12 months.

RESULTS:

A total of 52 ictal discharges in 13 patients started with a TShW. The center of TShW field was concordant with the final localization/lateralization, while that of the subsequent ictal discharge was concordant in only 6 patients. The subsequent rhythmic ictal discharge was non-localizing in 4 patients and misleading in the remaining 3 patients. The final localization was neocortical temporal or frontal in 11 patients, occipito-parietal in one, and undetermined in 1 patient. None of 61 ictal discharges in 15 patients with mesial temporal lobe epilepsy studied in the same time period started with a TShW.

CONCLUSION:

In this patient series, the TShW was a marker of neocortical seizure onset. The TShW field provided more accurate localization or lateralization of the ictal focus than the following rhythmic ictal discharge.

SIGNIFICANCE:

TShW at seizure onset should suggest a neocortical rather than hippocampal seizure onset.

PMID:
19264545
DOI:
10.1016/j.clinph.2009.01.010
[Indexed for MEDLINE]
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