Ictal source imaging and electroclinical correlation in self-limited epilepsy with centrotemporal spikes

- We analysed seizures in patients with self-limited epilepsy with centrotemporal spikes.
- Ictal source imaging showed activation of the operculo-insular area.
- Ictal EEG activity was time-locked to contralateral facial myoclonic jerks.
- The dynamics of the seizures was fragmented.

PurposeTo elucidate the localization of ictal EEG activity, and correlate it to semiological features in self-limited epilepsy with centrotemporal spikes (formerly called “benign epilepsy with centrotemporal spikes”).MethodsWe have performed ictal electric source imaging, and we analysed electroclinical correlations in three patients with self-limited epilepsy with centrotemporal spikes.ResultsThe source of the evolving rhythmic ictal activity (9.7-13.5 Hz) localized to the operculo-insular area. The rhythmic EEG activity was time-locked to the contralateral focal motor seizure manifestation: facial rhythmic myoclonic jerks, with the same frequency as the analysed ictal rhythm. In all three patients, the seizures had fluctuating course with pauses of clinical and electrographic seizure activity, ranging from 0.4 to 7 s.ConclusionSource imaging of ictal EEG activity in patients with self-limited epilepsy with centrotemporal spikes showed activation of the operculo-insular area, time-locked to the contralateral focal myoclonic jerks. Fragmented seizure dynamics, with fluctuating course, previously described as a hallmark in patients with psychogenic non-epileptic seizures, can occur in rolandic seizures.