SUMMARYPurpose: To evaluate the clinical significance of interictal regional polyspikes in focal epilepsies secondary to cortical dysplasia. Methods: We performed a data search for the term "regional polyspikes" in the database of our epilepsy-monitoring unit. Patients with generalized epilepsies including Lennox-Gastaut syndrome were excluded. Regional interictal epileptiform discharges were recorded in 513 patients with noninvasive EEG. Results: We identified 29 patients with interictal regional polyspikes and focal epilepsies. Another 484 patients showed regional epileptiform discharges other than polyspikes. The etiology of the epilepsy was significantly more frequently cortical dysplasia in the group of patients with regional polyspikes (35%, 10 of 29 patients) than in the patients with other regional epileptiform discharges (5%, 24 of 484 patients) (p < 0.01). The polyspikes were significantly more frequently localized to the extratemporal (72%; n = 21) than temporal (28%; n = 8) regions (p < 0.01). In contrast, regional epileptiform discharges other than polyspikes were significantly more frequently localized to the temporal lobe (75%; n = 362) than extratemporal regions (25%; n = 122) (p < 0.01). Eight of the 10 patients with focal cortical dysplasia had extratemporal polyspikes. Discussion: Noninvasively recorded regional polyspikes suggest cortical dysplasias as etiology of predominantly extratemporal epilepsies.

SUMMARYPurpose: We evaluated the role of interictal rhythmical midline theta (RMT) in the identification of frontal lobe epilepsy (FLE) and its differentiation from temporal lobe epilepsy (TLE) and nonepileptic controls. Methods: We included 162 individuals in the study: 54 FLE patients, 54 TLE patients, and 54 nonepileptic controls. Continuous electroencephalographic (EEG)-video monitoring was performed in all individuals. Interictal RMT was included only if it occurred during definite awake states. RMT associated with drowsiness or mental activation and ictal RMT was excluded. Results: We identified RMT significantly more frequently in FLE patients (48.1%, 26 of 54) than in TLE patients (3.7%, 2 of 54) (p < 0.01), and not in the control group. The average frequency was 6 Hz (range 5-7 Hz), and the average RMT bursts lasted 8 s (3-12 s). Interestingly, all mesial FLE patients (n = 4) (as established by invasive EEG recordings) showed RMT, whereas this was less frequently the case in the other FLE patients (44%, 22 of 50) (p = 0.03). Thirteen of our 54 patients with FLE (24%) did not have any interictal epileptiform discharges (IEDs), but RMT was observed in the majority of these patients (62%, 8 of 13). Conclusion: Interictal RMT is common and has a localizing value in patients with FLE, provided that conditions such as drowsiness and mental activation as confounding factors for RMT are excluded. RMT should be included in the evaluation of patients considered for resective epilepsy surgery.

The detailed analysis of seizure semiology is an essential tool for diagnosing epileptic patients and is particularly important in the evaluation of patients considered for epilepsy surgery. The meticulous clinical observation of epileptic seizures provides information about the localisation and lateralisation of the symptomatogenic zone. Here, we present a video atlas showing a variety of ictal and postictal localising and lateralising phenomena. [Published with video sequences]

SummaryWe report on a patient with right-sided Sturge-Weber syndrome (SWS), in whom earlier functional hemispherectomy failed. Subtraction of ictal and interictal singlephoton-emission-computed-tomography (SPECT) superimposed on individual MRI showed a right fronto-orbital hyperperfusion, with a left-sided EEG seizure pattern. Ictal SPECT supported our assumption that right frontal originated seizure pattern propagated to left hemisphere via the remaining right frontal bridge. Right orbito-frontal resection and disconnection from corpus callosum resulted in seizure freedom. © 2007 Elsevier B.V. All rights reserved.Sturge-Weber syndrome (SWS) is a sporadically occurring phakomatosis (Juhasz et al., 2007), which frequently leads to epilepsy, hemiparesis, and learning disability in association with a pial angioma (Aylett et al., 1999). Epilepsy affects most of these patients who may be good candidates for hemispherectomy if anti-epileptic medication does not control the seizures (Kossoff et al., 2002). Their presurgical evaluation includes non-invasive EEG-video monitoring and imaging studies. Ictal perfusion measured by single-photon-emission-computed-tomography (SPECT), particularly if subtracted from interictal SPECT and superimposed on MRI, can provide additional information in presurgical evaluation of patients with refractory extratemporal SWS (O'Brien et al., 2004 Case reportA 6-year-old boy had frequent daily bilateral asymmetric tonic seizures since he was 8 months old. He had been diagnosed to have right-sided SWS. He had flaccid hemiparesis on left side more than on the right, and was not able to stand or walk. He was mentally retarded and unable to speak. As he was resistant to multiple anti-epileptic drugs (AED), epilepsy surgery was performed in 2003. Temporal and central lobectomy and frontal and occipital hemispherotomy were performed on the right side. He was then seizure-free for 2 years, but the seizures started again in 2005.When the patient was admitted to our Epilepsy Monitoring Unit of the University of Munich Epilepsy Center in 2006 he had multiple daily motor seizures for 6 months. Phenobarbital treatment failed to control the seizures which occurred approximately 3-5 times a day. The seizures started with vocalization followed by left tonic and bilateral hypermotor seizures.0920-1211/$ -see front matter

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