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EEG in Epilepsy: Current Perspectives

Published online by Cambridge University Press:  02 December 2014

M. Sundaram ,
R.M. Sadler ,
G.B. Young  and
N. Pillay
M. Sundaram
Affiliation:
From the University of Mississippi, Jackson, MS USA
R.M. Sadler
Affiliation:
Dalhousie University, Halifax, NS Canada
G.B. Young
Affiliation:
University of Western Ontario, ON Canada
N. Pillay
Affiliation:
University of Calgary, AB Canada
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Abstract

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The electroencephalogram (EEG) plays an important diagnostic role in epilepsy and provides supporting evidence of a seizure disorder as well as assisting with classification of seizures and epilepsy syndromes. Emerging evidence suggests that the EEG may also provide useful prognostic information regarding seizure recurrence after a single unprovoked attack and following antiepileptic drug withdrawal. Continuous EEG video telemetry monitoring has an established role in the diagnosis of non-epileptic pseudo-seizures and in localizing the seizure focus for epilepsy surgery. Newer tools such as EEG mapping and magneto-encephalogram, although still investigational, appear potentially useful for defining the seizure focus in epilepsy. This review examines the traditional concepts of clinical EEG in the light of newly available data.

Résumé

RÉSUMÉ

L’électroencéphalogramme (ÉEG) joue un rôle diagnostique important dans l’épilepsie et fournit des données étayant le diagnostic d’épilepsie et aidant à sa classification. Des données récentes suggèrent que l’ÉEG peut aussi fournir des informations utiles pour determiner le pronostic quant à récurrence des crises après un épisode unique non provoqué et après le retrait de la medication antiépileptique. Le monitorage vidéo télémétrique continu de l’ÉEG a un rôle établi dans le diagnostic des pseudocrises non épileptiques et dans la localisation du foyer épileptogène en vue d’une chirurgie. Les nouveaux outils tells que la cartographie par ÉEG et le magnéto-encéphalogramme, bien qu’ils soient encore au stade expérimental, semblent potentiellement utiles pour identifier le foyer épileptogène dans l’épilepsie. Cet article de revue examine les concepts traditionnels de l’ÉEG en clinique à la lumière de données nouvelles.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 4 , November 1999 , pp. 255 - 262
Copyright
Copyright © The Canadian Journal of Neurological 1999

References

Refeeences

1. Jasper, H. Report of committee on methods of clinical exam inEEG. Electroencephalogr Clin Neurophysiol 1958; 10:370–375.Google Scholar
2. American EEG Society. Guidelines for standard electrode positionnomenclature. J Clin Neurophysiol 1991; 8:200–2.Google Scholar
3. Morris, HH, Luders, HL, Lesser, RP, Dinner, DS, Wyllie, E. Value ofclosely spaced electrodes in the localization of epileptiform foci: a study of 26 patients with complex partial seizures. Electroencephalogr Clin Neurophysiol 1987; 63:107–11.CrossRefGoogle Scholar
4. Rovit, RL, Gloor, P, Rassmussen, T. Sphenoidal electrodes in theelectrographic study of patients with temporal lobe epilepsy. J Neurosurg 1961; 18:151–158.Google Scholar
5. Sperling, MR, Mendius, JR, Engel, J. Jr. Mesial temporal spikes: asimultaneous comparison of sphenoidal, nasopharyngeal and ear electrodes. Epilepsia 1986; 27:81–86.CrossRefGoogle Scholar
6. Sadler, RM, Goodwin, J. Multiple electrodes for detecting spikes inpartial complex seizures. Can J Neurol Sci 1989; 16:326–329.Google Scholar
7. Kanner, AM, Ramirez, L, Jones, JC. The utility of placing sphenoidalelectrodes under the foramen ovale with fluoroscopic guidance. J Clin Neurophysiol 1995; 12:72–81.Google Scholar
8. Homan, RW, Jones, MC, Rowat, S. Anterior temporal electrodes incomplex partial seizures. Electroencephalogr Clin Neurophysiol 1988; 70:105–109.Google Scholar
9. Krauss, GL, Lesser, RP, Fisher, RS, Arroyo, S. Anterior “cheek” electrodes are comparable to sphenoidal electrodes for the identification of ictal activity. Electroencephalogr Clin Neurophysiol 1992; 83:333–338.Google Scholar
10. Quesney, LF. Seizures of frontal lobe origin. In: Meldrum, B, Pedley, TA. eds: Recent Advances in Epilepsy, No 3. Edinburgh: Churchill-Livingstone 1986; 81–110.Google Scholar
11. Gorney, DS. The practical guide to digital EEG. Am J EEG Technol 1992; 32:260–289.Google Scholar
12. Forster, O. Hyperventilations epilepsie Dtsch Z. Nervenheilkd 1924; 83:347–356.Google Scholar
13. Miley, CE, Forster, FM. Activation of partial complex seizures byhyperventilation. Arch Neurol 1977; 34:371–373.Google Scholar
14. Gabor, AJ, Ajmone-Marsan, C. Coexistence of focal and bilateraldiffuse paroxysmal discharges in epileptics: clinical – electrographic study. Epilepsia, 1969; 10:453–472.Google Scholar
15. Patel, VM, Maulsby, RL. How hyperventilation alters theelectroencephalogram: a review of controversial viewpoints emphasizing neurophysiological mechanisms. J Clin Neurophysiol, 1987; 4:101–120.Google Scholar
16. Newmark, ME, Penry, JK. Photosensitivity and Epilepsy: A Review. 1979; New York: Raven Press.Google Scholar
17. Reilly, EW, Peters, JF. Relationship of some varieties ofelectroencephalographic photosensitivity to clinical convulsivedisorders. Neurology 1973; 23:1040–1057.Google Scholar
18. Doose, H, Gerken, H, Hienvolpel, KF, Volzke, E. Genetics ofphotosensitive epilepsy. Neuropediatrie 1969; 1:56–73.Google Scholar
19. Kooi, K, Thomas, MH, Mortenson, FN. Photoconvulsive andphotomyoclonic responses in adults. An appraisal of their clinical significance. Neurology 1960; 10:1051–1058.Google Scholar
20. Gastaut, H, Trevisan, C, Naquet, R. Diagnosticvalue ofelectroencephalographic abnormalities provoked by intermittent photic stimulation. Electroencephalogr Clin Neurophysiol 1958; 10:194–195.Google Scholar
21. Gilliam, FG, Chiappa, KH. Significance of spontaneous epileptiformabnormalities associated with a photoparoxysmal response. Neurology 1995; 45:453–456.Google Scholar
22. de Graaf, AS, Lombard, CJ, Claassen, DA. Influence of ethnic andgeographic factors on the classic photoparoxysmal response in the electroencephalogram of epilepsy patients. Epilepsia 1995; 219:23.Google Scholar
23. Rodin, EA, Luby, ED, Gottlieb, JS. The electroencephalogramduring prolonged experimental sleep deprivation. Electroencephalogr Clin Neurophysiol 1962; 14:544–551.Google Scholar
24. Bennett, DR, Mattson, RH, Ziter, FA, Calverly, JR, Liske, EA, Pratt, RL. Sleep deprivation: neurological and electroencephalographic effects. Aerospace Med 1964; 35:888–890.Google Scholar
25. Mattson, RH, Pratt, KL, Calverly, JA. Electroencephalograms ofepileptics following sleep deprivation. Arch Neurol 1965; 13:310–315.Google Scholar
26. Pratt, KL, Mattson, RH, Weikers, NJ, Williams, R. EEG activation ofepileptics following sleep deprivation: a prospective study of 114 cases. Electroencephalogr Clin Neurophysiol 1968; 24:11–15.CrossRefGoogle ScholarPubMed
27. Geller, MR, Gourdji, N, Christoff, N, Fox, E. The effects of sleepdeprivation on the EEGs of epileptic children. Dev Med ChildNeurol 1969; 11:771–776.Google Scholar
28. Spadetta, V. La Privazivne di Sonno nella diagnosielettroencefalografica di epilessia. Act Neurol (Napoli) 1971; 26:7–13.Google Scholar
29. Scollo-Lavizzari, G, Pralle, W, De La Cruz, N. Activation effects ofsleep deprivation and sleep in seizure patients. Eur Neurol 1975; 13:1–5.Google Scholar
30. Degan, R. A study of the diagnostic value of waking and sleep EEGsafter sleep deprivation in epileptic patients on anticonvulsive therapy. Electroencephalogr Clin Neurophysiol 1980; 49:577–584.Google Scholar
31. Rowan, J, Veldhuisen, RJ, Nagelkerke, NJD. Comparative evolutionof sleep deprivation and sedated sleep EEGs as diagnostic aids in epilepsy. Electroencephalogr Clin Neurophysiol 1982; 54:357–364.CrossRefGoogle Scholar
32. Robin, JJ, Tolan, GD, Arnold, JW. Ten year experience withabnormal EEGs in asymptomatic adult males. Aviation Space Env Med 1978; 49: 732–736.Google Scholar
33. Gregory, RP, Oates, T, Merry, RTG. Electroencephalogramepileptiform abnormalities in candidates for aircrew training. Electroencephalogr Clin Neurophysiol 1993; 86:75–77.Google Scholar
34. Zivin, L, Ajmone-Marsan, C. Incidence and prognostic significanceof epileptiform activity in the EEG of nonepileptic subjects. Brain 1968; 91:751–778.Google Scholar
35. Eeg-Olofsson, O, Peterson, I, Sellden, V. The development of theelectroencephalogram in normal children from the age of one through fifteen years. Neuropaediatrie 1971; 4:375–404.CrossRefGoogle Scholar
36. Cavazzuti, GB, Cappella, L, Nalin, A. Longitudinal study ofepileptiform EEG patterns in normal children. Epilepsia 1980; 21:43–55.Google Scholar
37. Iida, N. Okada, S, Tsuboi, T. EEG abnormalities in nonepilepticpatients. Fol Psychiatr Neurol Jpn 1985; 39:43–58.Google Scholar
38. Okubo, Y, Matsuura, M, Asai, T, Asai, K, Kato, M, et al. EpileptiformEEG discharges in healthy children: prevalence, emotional and behavioral correlates and genetic influences. Epilepsia 1994; 35:832–841.CrossRefGoogle Scholar
39. Ajmone-Marsan, C, Zivin, LS. Factors related to the occurrence oftypical paroxysmal abnormalities in the EEG records of epileptic patients. Epilepsia 1970; 11:361–381.Google Scholar
40. Sundaram, M, Hogan, T, Hiscock, M, Pillay, N. Factors affectinginterictal spike discharges in adults with epilepsy. Electroencephalogr Clin Neurophysiol 1990; 75; 358––360.Google Scholar
41. Goodin, DS, Aminoff, MJ. Does the interictal EEG have a role in thediagnosis of epilepsy? Lancet 1984; i:837–839.Google Scholar
42. Salinsky, M, Kanter, R, Dasheiff, RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987; 28:331–334.Google Scholar
43. Mirsky, AF, Van Buren, JM. On the nature of the “Absence” incentroencephalic epilepsy: a study of some behavioral electroencephalographic and autonomic factors. Electroencephalogr Clin Neurophysiol 1965; 18:334–348.Google Scholar
44. Browne, TR, Penry, JK, Porter, RJ, Dreifuss, FE. Responsivenessbefore, during and after spike-wave paroxysms. Neurology 1974; 24:659–665.CrossRefGoogle ScholarPubMed
45. Aarts, JHP, Binnie, CD, Smit, AM, Wilkins, AJ. Selective cognitiveimpairment during focal and generalized epileptiform EEG activity. Brain 1984; 107:293–308.Google Scholar
46. Binnie, CD, Marston, D. Cognitive correlates of interictaldischarges. Epilepsia 1992; 33 (Suppl. 6):S11– S17.Google Scholar
47. Kasteleijn-Nolst Trenite, DGA, Riemersma, JBJ, Binnie, CD, Smit, AM, Meinardi, H. The influence of subclinical epileptiform EEG discharges on driving behavior. Electroencephalogr ClinNeurophysiol 1987; 67: 167–170.Google Scholar
48. Kasteleijn-Nolst Trenite, DGA, Bakker, DJ, Binnie, CD, Buerman, A, Van Raaij, M. Psychological effects of subclinical epileptiform discharges: scholastic skills. Epilepsy Res 1988; 2:111–116.Google Scholar
49. Siebelink, BM, Bakker, DJ, Binnie, CD, Kasteleijn-Nolst Trenite, DGA. Psychological effects of subclinical epileptiform EEG discharges in children: general intelligence tests. Epilepsy Res 1988; 2:117–121.Google Scholar
50. Blume, WT, Young, GB, Lemieux, JF. EEG morphology of partialepileptic seizures. Electroencephalogr Clin Neurophysiol 1984; 57:295–302.CrossRefGoogle ScholarPubMed
51. Geiger, LR, Harner, RN. EEG patterns at the time of focal seizureonset. Arch Neurol 1978; 35:276–286.Google Scholar
52. Sharbrough, FW. Scalp recorded ictal patterns in focal epilepsy. J Clin Neurophysiol 1993; 10:262–267.Google Scholar
53. Alarcon, G, Binnie, CD, Elwes, RDC, Polkey, CE. Power spectrumand intracranial EEG patterns at seizure onset in partial epilepsy. Electroencephalogr Clin Neurophysiol 1995; 94:326–337.CrossRefGoogle Scholar
54. Kaibara, M, Blume, WT. The postictal electroencephalogram. Electroencephalogr Clin Neurophysiol 1988; 70:99–104.Google Scholar
55. Devinsky, O, Kelley, K, Porter, RJ, Theodore, WH. Clinical andelectroencephalographic features of simple partial seizures. Neurology 1988; 38:1347–1352.Google Scholar
56. Bare, MA, Burnstine, TH, Fisher, RS, Lesser, RP. Electroencephalographic changes during simple partial seizures. Epilepsia 1994; 35:715–720.Google Scholar
57. Gastaut, H, Broughton, R. Epileptic Seizures. Clinical and Electrographic Seizures: Diagnosis and Treatment. Springfield,Ill: Charles C. Thomas 1972.Google Scholar
58. Young, GB, Goodenough, P, Jacono, V, Schieven, JR. Periodiclateralized epileptiform discharges (PLEDs): electrographic andclinical features. Am J EEG Technol 1988; 28: 1–13.Google Scholar
59. Handforth, A, Cheng, JT, Mandelkern, MA, Treiman, DM. Markedlyincreased mediotemporal lobe metabolism in a case with PLEDs: further evidence that PLEDs are a manifestation of partial status epilepticus. Epilepsia 1994; 35:876–881.Google Scholar
60. Treiman, DM. Generalized convulsive, nonconvulsive and focalstatus epilepticus. In: Feldman, E. Ed. Current Diagnosis in Neurology. St. Louis: Mosby-Yearbook, 1994: 11–18.Google Scholar
61. Reiher, J, Rivest, J, Grand’Maison, F, Leduc, CP. Periodic lateralizedepileptiform discharges with transitional rhythmic discharges: association with Seizures. Electroencephalogr Clin Neurophysiol 1991; 78:12–17.Google Scholar
62. Treiman, DM. Electroclinical features of status epilepticus. J ClinNeurophysiol 1995; 12:343–362.Google Scholar
63. Berg, AT, Shinnar, S. The risk of seizure recurrence following a firstunprovoked seizure: a quantitative review. Neurology 1991; 41: 965–972.Google Scholar
64. Shinnar, S, Kang, H, Berg, AT, Goldensohn, ES, Hauser, WA, Moshe, SL. EEG abnormalities in children with a first unprovoked seizure. Epilepsia 1994; 35: 471–476.Google Scholar
65. Hauser, WA, Rich, SS, Annegers, JF, Anderson, VE. Seizurerecurrence after a 1st unprovoked seizure: an extended follow up. Neurology 1990; 40: 1163–1170.Google Scholar
66. Van Donselaar, CA, Schimsheimer, RJ, Geerts, AT, Declerck, AC. Value of the electroencephalogram in adults with untreated idiopathic first seizures. Arch Neurol 1992; 42: 231–287.Google Scholar
67. First seizure trial group. Randomized clinical trial on the efficacyof anti-epileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology 1993; 43: 478–483.Google Scholar
68. Hopkins, A, Garman, A, Clarke, C. The first seizure in adult life:value of clinical features, electroencephalography, and computerized tomographic scanning in prediction of seizure recurrence. Lancet 1988; 1: 721–726.CrossRefGoogle ScholarPubMed
69. Tennison, MT, Greenwood, R, Lewis, D, Thorn, M. Discontinuingantiepileptic drugs in children with epilepsy. A comparison of a six week and nine month taper period. N Engl J Med 1994; 330: 1407–1410.Google Scholar
70. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Prognostic index for recurrence of seizures afterremission of epilepsy. Br Med J 1993; 306: 1374–1378.Google Scholar
71. Shinnar, S. Berg, AT, Moshe, SL, Kang, H, O’Dell, C, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol 1994: 35:534–545.Google Scholar
72. Berg, AT, Shinnar, S. Relapse following discontinuation ofantiepileptic drugs: a meta analysis. Neurology 1994; 44:601–8.Google Scholar
73. Gates, JR, Ramani, V, Whalen, SM, Loewenson, R. Ictalcharacteristics of pseudoseizures. Arch Neurol 1985; 42:1183–1187.Google Scholar
74. Donat, JF, Wright, FS. Episodic symptoms mistaken for seizures inthe neurologically impaired child. Neurology 1990; 40:156–157.Google Scholar
75. Aldrich, MS, Jahnke, B. Diagnosticvalueof video-EEG polysomnography. Neurology 1991; 41:1060–1066.Google Scholar
76. Penry, JK, Porker, RJ, Dreifuss, FE. Simultaneous recording ofabsence seizures with videotape and electroencephalography. Brain 1975; 98:427–440.Google Scholar
77. Quesney, LF, Constrain, M, Fish, DR, Rasmussen, T. The clinicaldifferentiation of seizures arising in the parasagittal and anterolaterodorsal frontal cowexities. Arch Neurol 1990; 47:477–479.Google Scholar
78. Arfel, G, Laurette, G. Evolution of paroxysmal discharges assessedby radiotelemetry in an infant with gelastic seizures. Electroencephalogr Clin Neurophysiol 1975; 39:554.Google Scholar
79. Lesser, RP, Fisher, RS, Kaplan, P. The evaluation of patients withintractable complex partial seizures. Electroencephalogr ClinNeurophysiol 1989; 73:381–388.CrossRefGoogle ScholarPubMed
80. Rowan, AJ, Pippenger, CE, McGregor, PA, French, JH. Seizureactivity and anticonvulsant drug concentration – 24 hour sleepwaking studies. Arch Neurol 1975; 32:281–288.Google Scholar
81. Rowan, AJ, Binnie, CD, DeBeer-Pawlikowski, NKB, et al. Sodiumvalproate: serial monitoring of EEG and serum levels. Neurology 1979; 29:1450–1459.Google Scholar
82. Stevens, JR, Lonsbury, BL, Goel, SL. Seizure occurrence andinterictalspike interval-telemetered electroencephalogramstudies. Arch Neurol 1972; 26:409–19.Google Scholar
83. Gotman, J, Marciani, MG. Electroencephalographic spiking activity,drug levels and seizure occurrence in epileptic patients. AnnNeurol 1985; 17:597–603.Google Scholar
84. Leroy, RF, Rao, KK, Voth, BJ. Intensive neurodiagnostic monitoringin epilepsy using ambulatory cassette EEG with simultaneous video recording. In: Ebersole, JS, ed. Ambulatory EEG Monitoring. New York: Raven Press, 1998.Google Scholar
85. Ives, JR, Thompson, CJ, Gloor, P. Seizure monitoring: a new tool inelectroencephalograph. Electroencephalogr Clin Neurophysiol 1976; 41:422–427.Google Scholar
86. Kamp, A. Amplification and transmission of the EEG. In: Long Term Monitoring in Epilepsy, Eds, Gotman, J., Ives, J.R., Gloor, P. Electroencephalogr Clin Neurophysiol 1985; 37:27–60.Google Scholar
87. Binnie, CD, Rowan, AJ, Overweg, J, Meinardi, H, Wisman, T, et al. Telemetric EEG and video monitoring in epilepsy. Neurology 1981; 31:298–303.Google Scholar
88. Epstein, CM. Computerized EEG in the courtroom. Neurology 1994; 44:1566–1569.Google Scholar
89. Nuwer, MR, Hauser, HM. Erroneous diagnosis using EEGdiscriminant analysis. Neurology 1994; 44: 1998–2000.Google Scholar
90. Lopes da Silva, FH. A critical review of clinical applications oftopographic mapping of brain potentials. J Clin Neurophysiol 1990; 7:535–551.Google Scholar
91. Wong, PKH. Stability of source estimates in rolandic spikes. Brain Topogr 1989:2:31–36.Google Scholar
92. Ebersole, JS. Non-invasive localization of the epileptogenic focusby EEG dipole modeling. Acta Neurol Scand 1994; Supp 152:20–28.Google Scholar
93. Sutherling, WW, Barth, DS. Magneto-encephalography in clinicalepilepsy studies. The UCLA experience. Adv Neurol 1990; 54:231–245.Google Scholar
94. Paetau, R, Kajola1, M, Karhu, J, Nousiainen, V, Partanen, J, etal. Magnetoencephalographic localization of epileptic cortex – impact on surgical treatment. Ann Neurol 1992; 32:106–109.Google Scholar