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Epilepsia. 2015 Jun;56(6):959-67. doi: 10.1111/epi.13010. Epub 2015 May 19.

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography.

Author information

1
Pacific Epilepsy Program, Pacific Medical Center, San Francisco, California, 94115, U.S.A.
2
NeuroPace, Inc., Mountain View, California, 94043, U.S.A.
3
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, U.S.A.
4
Department of Neurology, Indiana University, Indianapolis, Indiana, 46202, U.S.A.
5
Oregon Health and Science University, Portland, Oregon, 97239, U.S.A.
6
USC Comprehensive Epilepsy Program, Los Angeles, California, 90089, U.S.A.
7
Baylor College of Medicine, Houston, Texas, 77030, U.S.A.
8
Dartmouth-Hitchcock Epilepsy Center, Lebanon, New Hampshire, 03756, U.S.A.
9
George Washington University, Washington, District of Columbia, 20052, U.S.A.
10
Johns Hopkins Epilepsy Center, Baltimore, Maryland, 21287, U.S.A.
11
Department of Neurology, University of Florida, Gainesville, Florida, 32611, U.S.A.
12
Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, U.S.A.
13
Rush Epilepsy Center, Chicago, Illinois, 60612, U.S.A.
14
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
15
MGH Epilepsy Service, Massachusetts General Hospital, Boston, Massachusetts, 02114, U.S.A.
16
Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, U.S.A.
17
Cleveland Clinic Neurological Institute, Cleveland, Ohio, 44195, U.S.A.
18
Swedish Neuroscience Institute, Seattle, Washington, 98052, U.S.A.
19
Georgia Regents University, Augusta, Georgia, 30912, U.S.A.
20
University of Wisconsin, Madison, Wisconsin, 53792, U.S.A.
21
Comprehensive Epilepsy Center, University of Virginia, Charlottesville, Virginia, 22908, U.S.A.
22
Mayo Clinic Jacksonville, Jacksonville, Florida, 32224, U.S.A.
23
Yale University School of Medicine, New Haven, Connecticut, 06510, U.S.A.
24
Comprehensive Epilepsy Center, Miami Children's Hospital, Miami, Florida, 33155, U.S.A.
25
Henry Ford Hospital, Detroit, Michigan, 48202, U.S.A.
26
The Medical University of South Carolina, Charleston, South Carolina, 29425, U.S.A.
27
Institute of Neurology and Neurosurgery at Saint Barnabas, Livingston, New Jersey, 07039, U.S.A.
28
University of Rochester Medical Center, Rochester, New York, 14642, U.S.A.
29
Via Christi Comprehensive Epilepsy Center, Wichita, Kansas, 67214, U.S.A.
30
Stanford Comprehensive Epilepsy Center, Stanford, California, 94305, U.S.A.

Abstract

OBJECTIVE:

Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected bilateral MTL epilepsy in order to assess the time required to determine the seizure lateralization and whether this information could influence treatment decisions.

METHODS:

Ambulatory ECoG was reviewed in patients with suspected bilateral MTL epilepsy who were among a larger cohort with intractable epilepsy participating in a randomized controlled trial of responsive neurostimulation. Subjects were implanted with bilateral MTL leads and a cranially implanted neurostimulator programmed to detect abnormal interictal and ictal ECoG activity. ECoG data stored by the neurostimulator were reviewed to determine the lateralization of electrographic seizures and the interval of time until independent bilateral MTL electrographic seizures were recorded.

RESULTS:

Eighty-two subjects were implanted with bilateral MTL leads and followed for 4.7 years on average (median 4.9 years). Independent bilateral MTL electrographic seizures were recorded in 84%. The average time to record bilateral electrographic seizures in the ambulatory setting was 41.6 days (median 13 days, range 0-376 days). Sixteen percent had only unilateral electrographic seizures after an average of 4.6 years of recording.

SIGNIFICANCE:

About one third of the subjects implanted with bilateral MTL electrodes required >1 month of chronic ambulatory ECoG before the first contralateral MTL electrographic seizure was recorded. Some patients with suspected bilateral MTL seizures had only unilateral electrographic seizures. Chronic ambulatory ECoG in patients with suspected bilateral MTL seizures provides data in a naturalistic setting, may complement data from inpatient video-EEG monitoring, and can contribute to treatment decisions.

KEYWORDS:

Ambulatory EEG; EEG monitoring; Electrocorticography; Intracranial EEG; Localization; Responsive stimulation

PMID:
25988840
PMCID:
PMC4676303
DOI:
10.1111/epi.13010
[Indexed for MEDLINE]
Free PMC Article

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