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Very slow EEG responses lateralize temporal lobe seizures

An evaluation of non-invasive DC-EEG

From the Regional Epilepsy Center (Drs. Vanhatalo, Holmes, and Miller), Departments of Neurology and Neurological Surgery, University of Washington, Seattle; and Department of Biosciences (Drs. Vanhatalo, Voipio, and Kaila, and P. Tallgren), University of Helsinki, Finland.

Address correspondence and reprint requests to Dr. John W. Miller, Regional Epilepsy Center, University of Washington, Box 359745, 325 Ninth Ave., Seattle, WA 98104; e-mail: millerjw{at}u.washington.edu

Background: This study tested the idea that very slow EEG responses (direct current [DC] potential shifts) could be detected noninvasively during temporal lobe (TL) seizures, and that these shifts give lateralizing information consistent with that obtained by other methods.

Methods: Seven patients with TL epilepsy (TLE) were recorded with scalp DC-EEG technique at bedside. All recordings were performed simultaneously with conventional EEG (scalp in five, and intracranially in two; two patients with scalp recordings were recorded intracranially later). Seizures in five patients originated in the mesial TL. Ictal DC shifts were evaluated by comparing them to the temporal evolution of ictal discharges, and by comparing the laterality of these shifts to the side of seizure onset defined by routine EEG and other presurgical diagnostic tests.

Results: All seizures (35/35) were associated with negative DC shifts at temporal derivations (30 to 150 µV relative to vertex), beginning at the electrical seizure onset, and lasting for the whole seizure. In eight seizures (five patients) with documented mesial TL onset, the polarity of the DC shift was initially positive followed by a negative one after lateral spread of seizure activity. In all cases, the side of the EEG shift agreed with other diagnostic tests, and, at times, was more clearly lateralized than the conventional scalp EEG.

Conclusions: DC-EEG recordings are practical and achievable at the bedside. Ictal DC shifts are consistently observed in scalp recordings in TL seizures, and reliably lateralize them. This method may hold promise in reducing the need for invasive monitoring in patients with TLE where other noninvasive tests are equivocal.