Interictal and ictal activity recorded with subdural electrodes during preoperative evaluation for surgical treatment of epilepsy

Abstract

A total of 94 subdural strip electrodes were implanted in 22 patients during preoperative EEG evaluation for surgery of epilepsy. Eighteen patients had temporal lobe seizure onset, three had frontal lobe seizure onset, and one had occipital lobe seizure onset. Most electrodes (total, 83) were localized over the temporal lobe cortex, but in four cases additional strip electrodes (total, 11) covered the frontal, parietal, and occipital lobe cortexes. The electrodes were left in place for up to 28 days. No complications occurred. Interictally, focal spiking was recorded subtemporally, mostly without being seen in electrodes recording from the lateral temporal cortex. In three patients studied with simultaneous subdural and sphenoidal wire electrodes, spiking recorded from subdural electrodes was often not seen in the sphenoidal recording. There were 151 seizures recorded (with or without simultaneous video monitoring). The mean number of seizures per patient was 6.7 (range, 0–21). The seizures were classified as having focal (80 seizures) or local (71 seizures) onset. It is concluded that subdural electrodes are safe and have a sufficient selectivity with regard to localization of interictal spiking and seizure onset in patients with mesial temporal epileptic lesions. In such cases, electrodes have to be placed subtemporally. Other cortical areas may also be explored with these electrodes.