Sleep state and seizure foci related to depth spike activity in patients with temporal lobe epilepsy

Lieb, Jeffrey P.; Joseph, Jean Paul; Engel, Jerome; Walker, Jeffrey; Crandall, Paul H.

doi:10.1016/0013-4694(80)90396-x

Cited by 114 publications

(82 citation statements)

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“…Adult partial epilepsies, conversely, are accompanied by increased spiking related to the delta frequency range (9,10). The same tendency in spike activation was reported earlier by several visually scored studies (11)(12)(13) finding highest levels of spike activation during deep NREM stages in most temporal lobe epilepsy (TLE) patients. Nevertheless, both visually scored and spectralanalysis studies revealed small groups of patients deviating from this trend, exhibiting maximal spiking rates during light NREM, REM, or waking.…”

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confidence: 71%

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Interictal Epileptic Spiking during Sleep and Wakefulness in Mesial Temporal Lobe Epilepsy: A Comparative Study of Scalp and Foramen Ovale Electrodes

et al. 2003

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Summary:Purpose: To assess distribution of temporal lobe spikes across different states of sleep and wakefulness in simultaneous scalp and foramen ovale (Fo) recordings.Methods: The study included 12 patients with mesial temporal lobe epilepsy (MTLE). As part of their presurgical evaluation, patients underwent long-term video-EEG monitoring with combined scalp and foramen ovale electrodes (FoEs). In addition to traditional sleep scoring, waking was subdivided into eyes-opened and eyes-closed states, and rapid-eyemovement (REM) sleep was divided into phasic and tonic states. Spike counts were carried out visually for scalp and FoEs, and spiking rates were determined for each state. A ratio between FoE and scalp spiking rates also was calculated for each state.Results: Scalp spiking showed a significant increase during NREM3,4, whereas FoE spiking increased during NREM2. The scalp/FoE ratio significantly increased during NREM3,4. A significant difference in spiking rate also was found between phasic and tonic REM states as well as between waking with eyes opened and closed in FoE recordings.Conclusions: Our data provide evidence of a discrepancy in spike distribution across different states of sleep and waking monitored by scalp and FoE recordings. We suggest that these discrepancies may reflect differences in archicortical and neocortical spike synchronization. Key Words: Mesial temporal lobe epilepsy-Sleep-Interictal spike-Foramen ovaleHippocampus.Sleep-related modulation of epileptic activity is a well-known common feature of different epilepsy syndromes. Non-rapid-eye-movement (NREM) sleep has been shown by most authors to activate interictal epileptic activity in both partial (1) and primary generalized epilepsy syndromes (2), whereas REM and waking has a contrary effect. Considerable controversy surrounds the issue of whether light NREM or deep NREM sleep exerts a stronger facilitatory effect on spiking. There is accumulating evidence that this may depend on the type of epilepsy syndrome being studied. According to recent spectral analysis results, a range of idiopathic childhood epileptic syndromes (3-8) can be characterized by increased spiking in the sigma range related to spindle synchronization present mainly during NREM2. Adult partial epilepsies, conversely, are accompanied by increased spiking related to the delta frequency range (9,10). The same tendency in spike activation was reported earlier by several visually scored studies (11-13) finding highest levels of spike activation during deep NREM stages in most temporal lobe epilepsy (TLE) patients. Nevertheless, both visually scored and spectralanalysis studies revealed small groups of patients deviating from this trend, exhibiting maximal spiking rates during light NREM, REM, or waking.A second point of controversy concerns the spiking properties of mesiotemporal structures. There are reports describing maximal spike activation mainly during deep NREM stages (11,12), whereas other authors described increased spiking mainly during light NREM stages ...

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confidence: 71%

“…There are reports describing maximal spike activation mainly during deep NREM stages (11,12), whereas other authors described increased spiking mainly during light NREM stages (14)(15)(16). There also are hints that state-dependency in spiking is further modulated by additional factors such as the degree of local epileptogenicity (12).…”

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confidence: 99%

Interictal Epileptic Spiking during Sleep and Wakefulness in Mesial Temporal Lobe Epilepsy: A Comparative Study of Scalp and Foramen Ovale Electrodes

et al. 2003

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“…However, this concordance rose to 92% when principal spikes on all subdural recordings (MCPS) of a patient were summed (Table 4). This improved congruence reflects the greater seizure-localizing value of consistent, state-independent spiking noted in scalp EEG and depth studies (17,18). Our data indicate that subdural interictal spike location should not be ignored in assessing epileptogenesis: if initial subdurally recorded temporal seizures arise contralateral to subdural or scalp spikes, additional seizures should be sought before explantation of electrodes.…”

Section: Discussionmentioning

confidence: 70%

“…Our data indicate that subdural interictal spike location should not be ignored in assessing epileptogenesis: if initial subdurally recorded temporal seizures arise contralateral to subdural or scalp spikes, additional seizures should be sought before explantation of electrodes. Weaker spike-seizure correlations have been found with depth electrode studies (11,(18)(19)(20)(21)(22), perhaps because of smaller cortical volume sampled with depth electrodes. Using automated means to detect, describe, and localize spikes recorded by depth and/or subdural electrodes, Hufnagel et al (23) obtained good correlations with regions of seizure origin.…”

Section: Discussionmentioning

confidence: 99%

Temporal Epileptogenesis: Localizing Value of Scalp and Subdural Interictal and Ictal EEG Data

2001

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Summary:Purpose: To determine the value of scalp epileptiform EEG data and subdural interictal spikes in localizing temporal epileptogenesis among patients requiring invasive recordings. For this delineation, we related such factors to site of subdural seizure origin in 27 consecutive patients.Methods: Patients with temporal lobe epilepsy whose noninvasive lateralizing data were inconclusive and therefore required subdural electroencephalography were studied. All patients had (a) 24-h scalp telemetered EEGs, (b) adequate bitemporal subdural placements with an inferomesial line extending from a posterior burr hole anteriorly to <2.5 cm from anterior uncus and a lateral line reaching within 2.5 cm of the temporal tip, and (c) Ն2 subdurally recorded seizures.Results: Three hundred one (96%) of 314 subdurally recorded clinical seizures involving all 27 patients arose from a discrete focus; 266 (85%) arose from mesial temporal regions, which was the origin of the majority of seizures in 24 (89%) patients. The majority of subdural seizures arose ipsilateral to the majority of scalp EEG spikes in 22 (81%) of 27, and most subdural seizures of 15 (75%) of 20 arose ipsilateral to scalp seizures. Lateralization of interictal subdural spikes correlated with that of subdural seizures in 74-92% of patients, depending on the method of spike compilation; for example, most subdural seizures arose from the same lobe of most consistent principal temporal spikes in 92% of patients. These indices of epileptogenesis also appeared more commonly on the side of effective (Ն90% improvement) temporal lobectomy than contralaterally in the following proportions: most consistent principal subdural spikes, 86% of patients ipsilateral vs. 9% contralateral; scalp-recorded clinical seizures, 55% vs. 18%; scalp EEG spikes, 45% vs. 9%.Conclusions: Even among patients whose scalp data are sufficiently complex to require invasive recording for clarification, lateralization of temporal scalp interictal and ictal epileptiform activity and subdural interictal spikes should be included when assessing the side of temporal epileptogenesis. Key Words: Temporal epileptogenesis-Scalp data-Subdural data.Incredibly, virtually all writings on temporal lobe subdural electroencephalography have focused on its value relative to depth recordings (1-3). This preoccupation has limited both the amount of essential subdural electrode coverage and the extent of data analysis. As locations of scalp EEG abnormalities and those of subdural interictal findings may contribute to management decisions, their relative capabilities in identifying the principal epileptogenic zones needs evaluation. Surgical decisions hinge on the congruency of data indicating sites of epileptogenesis. Subdural recordings are terminated when the likelihood of any further contribution to congruency appears minimal. As the origin(s) of clinically typical seizures constitutes a cornerstone of this assessment, the clinician must decide when an adequate sample of seizures has been obtained. The value o...

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“…Não foi possível estabelecer a diferença de descargas encontradas nas várias fases do sono, pois o sistema utilizado em nosso estudo não possui os sensores adequados para diferenciar as várias fases do sono (EMG queixo e EOG). Entretanto resultados semelhantes em relação ao sono noturno foram descritos por vários autores [25][26][27][28][29] .…”

Section: Aspectos Quantitativos -Sono E Vigíliaunclassified

Monitorização eletroencefalográfica ambulatorial na epilepsia de difícil controle da infância

Rizzutti

Muszkat

Campos

2001

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo foi analisar através da monitorização eletroencefalográfica ambulatorial contínua e prolongada a distribuição temporal de descargas paroxísticas em sono e em vigília de crianças e adolescentes com epilepsia de difícil controle medicamentoso. Foram selecionadas 21 pacientes na faixa etária de 4 a 17 anos de idade com epilepsia de difícil controle medicamentoso, sendo 52,3 % (n=11) do sexo masculino e 47,7 % (n=10) do feminino, provenientes da Disciplina de Neurologia da Universidade Federal de São Paulo. Os exames foram realizados com o equipamento Bioware EEG-2008 de monitorização eletroencefalográfica ambulatorial prolongada (Holter cerebral). Observamos maior frequência das descargas epilépticas isoladas e agrupadas no sono diurno e noturno em relação a vigília; o sono, diurno e noturno, levou a ativação de descargas epilépticas, tanto isoladas como agrupadas. O Holter cerebral foi mais eficaz em detectar descargas epileptiformes do que o EEG de rotina em 33,33% dos pacientes. O Holter cerebral se mostrou método útil e preciso na detecção de descargas epilépticas, auxiliando na avaliação das flutuações da frequência da atividade paroxística em crianças com epilepsia de difícil controle medicamentoso, tanto em relação as atividades da vida cotidiana, quanto em relação ao ciclo biológico de sono e vigília.PALAVRAS-CHAVE: epilepsia, eletroencefalografia, criança, adolescência. Eletroencephalographic monitoring in refractory epilepsies in childhoodABSTRACT -The objective of our study was, by means of continuous prolonged ambulatory electroencephalographic monitoring, to analyze the temporal distribution of paroxysmal discharges during sleep and awake in children and adolescents with refractory epilepsies. Twenty-one patients in the 4-to-17 year age bracket with refractory epilepsies, with 52.3% (n=11) male and 47.6% (n=10) female from the Discipline of Neurology of the Universidade Federal de São Paulo (Federal University of São Paulo). Cerebral Holter was carried out with Bioware EEG-2008 of prolonged ambulatory electroencephalographic monitoring equipment. We observed greater frequency of isolated and grouped epileptic discharges in day and in night sleep in relation to awake; day and night sleep led to activation of epileptic discharges, both isolated and grouped. The cerebral Holter was more effective in detecting epileptiform discharges than the routine EEG in 33.33% of the patients. The cerebral Holter proved a useful and precise method in detecting epileptic discharges, as an aid in the assessment of the fluctuations in frequency of paroxysmal activity in children with refractory epilepsies, both in relation to activities in daily life, and to the relation to the biological cycle of sleep and awake.

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Sleep state and seizure foci related to depth spike activity in patients with temporal lobe epilepsy

Cited by 114 publications

References 10 publications

Interictal Epileptic Spiking during Sleep and Wakefulness in Mesial Temporal Lobe Epilepsy: A Comparative Study of Scalp and Foramen Ovale Electrodes

Interictal Epileptic Spiking during Sleep and Wakefulness in Mesial Temporal Lobe Epilepsy: A Comparative Study of Scalp and Foramen Ovale Electrodes

Temporal Epileptogenesis: Localizing Value of Scalp and Subdural Interictal and Ictal EEG Data

Monitorização eletroencefalográfica ambulatorial na epilepsia de difícil controle da infância

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