Electric Source Imaging in Temporal Lobe Epilepsy

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The objective of this study was to determine the validity of interictal spike (IIS) source localization in temporal lobe epilepsies (TLE) using stereoelectroencephalography as a validating method. Twenty patients with drug-resistant TLE were studied with high-resolution EEG and stereoelectroencephalography. Sixty-four scalp channels, a realistic head model, and different algorithms were used. For each patient, the intracerebral interictal distribution was studied and classified into one of three groups: L (mainly lateral), ML (mediolateral), and M (medial). In group L (three patients), surface IIS were recorded with a high signal-to-noise ratio. Source localizations designated all or part of the intracerebral interictal distribution. In group ML (11 patients), 8 patients had surface IIS, only 5 of which were localizable. High-resolution EEG permitted localization of the more lateral portion and definition of its rostrocaudal extension. A common pattern was identified in three patients with a predominant role of the temporal pole. In group M (six patients), four patients had rare surface IIS, none of which were localizable. Surface EEG does not record IIS limited to medial temporal lobe structures. In TLE with a mediolateral or a lateral interictal distribution, only the lateral component is detectable on surface EEG and accurately localizable by source localization tools.

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