Learn how to interpret and use intracranial EEG findings

B Frauscher; D Mansilla; C Abdallah; A Astner-Rohracher; S Beniczky; M Brazdil; V Gnatkovsky; J Jacobs; G Kalamangalam; P Perucca; P Ryvlin; S Schuele; J Tao; Y Wang; M Zijlmans; A McGonigal

doi:10.1002/epd2.20190

Learn how to interpret and use intracranial EEG findings

Epileptic Disord. 2024 Feb;26(1):1-59. doi: 10.1002/epd2.20190. Epub 2024 Feb 13.

Authors

B Frauscher^{1

2}, D Mansilla^{2

3}, C Abdallah², A Astner-Rohracher⁴, S Beniczky^{5

6}, M Brazdil^{7

8}, V Gnatkovsky⁹, J Jacobs^{10

11}, G Kalamangalam^{12

13}, P Perucca^{14

15

16

17

18}, P Ryvlin¹⁹, S Schuele²⁰, J Tao²¹, Y Wang^{9

13}, M Zijlmans^{22

23}, A McGonigal^{24

25}

Affiliations

¹ Department of Neurology, Duke University Medical Center and Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA.
² Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, Montreal, Québec, Canada.
³ Neurophysiology Unit, Institute of Neurosurgery Dr. Asenjo, Santiago, Chile.
⁴ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁵ Danish Epilepsy Centre, Dianalund, Denmark.
⁶ Aarhus University, Aarhus, Denmark.
⁷ Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Member of the ERN-EpiCARE, Brno, Czechia.
⁸ Behavioral and Social Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno, Czechia.
⁹ Department of Epileptology, University Hospital Bonn, Bonn, Germany.
¹⁰ Department of Paediatrics and Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹¹ Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
¹² Department of Neurology, University of Florida, Gainesville, Florida, USA.
¹³ Wilder Center for Epilepsy Research, University of Florida, Gainesville, Florida, USA.
¹⁴ Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.
¹⁵ Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
¹⁶ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
¹⁷ Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.
¹⁸ Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁹ Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Lausanne, Switzerland.
²⁰ Department of Neurology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA.
²¹ Department of Neurology, The University of Chicago, Chicago, Illinois, USA.
²² Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
²³ Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
²⁴ Department of Neurosciences, Mater Misericordiae Hospital, Brisbane, Queensland, Australia.
²⁵ Mater Research Institute, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.

PMID: 38116690
DOI: 10.1002/epd2.20190

Abstract

Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.

Keywords: atlas; interictal epileptiform discharges; intracranial electroencephalography; low-voltage fast activity; pathology; prognosis; seizure-onset pattern; stereo-electroencephalography.

MeSH terms

Child
Drug Resistant Epilepsy* / diagnosis
Drug Resistant Epilepsy* / surgery
Electrocorticography / methods
Electroencephalography / methods
Epilepsies, Partial* / diagnosis
Epilepsies, Partial* / surgery
Epilepsy*
Humans
Seizures / diagnosis

Abstract

MeSH terms

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