Usefulness of intracranial EEG in the decision process for epilepsy surgery

SummaryBackground and purposeIn patients with discordant results, non-localizing EEG, or bitemporal seizure onset, intracranial monitoring is done to confirm the seizure onset. Our aim was to assess the yield of intracranial recordings in patients with different clinical scenarios.MethodsThe records of all patients who underwent prolonged intracranial EEG monitoring (IEM) at the London Health Sciences Centre, University of Western Ontario, Canada, between 1993 and 1999, identified using our EEG patient database in continuous use since December 1972, were reviewed. Patients were analyzed in the following groups according to perceived increasing degrees of uncertainty of epileptic zone localization—group 1: lesion on MRI congruent with focal ictal and interictal scalp EEG, but findings are subtle and of low level of certainty (n = 13), group 2: focal MRI, focal ictal and multifocal interictal scalp EEG (n = 11), group 3: focal MRI, non-localizing or incongruent scalp EEG (n = 73), group 4: normal of multifocal MRI, focal ictal scalp EEG (n = 11), group 5: multifocal MRI, non-localizing scalp EEG (n = 18), and group 6: normal MRI, multifocal scalp EEG (n = 36).ResultsOne hundred and seventy one patients underwent IEM at the London Health Sciences Centre between 1993 and 1999. All patients had localization-related epilepsy, plus or minus secondary generalization. IEM was helpful overall in 86% of patients, in 69% of group 1, 36% of group 2, 90% of group 3, 81% of group 4, 100 of group 5 and 92% of group 6.ConclusionsOur study shows that the yield of the IEM was higher in the groups of patients with lack of congruence between the MRI and the scalp EEG. The yield was lower in patients with congruent but subtle or uncertain scalp EEG and MRI findings.