Features of Simultaneous Scalp and Intracranial EEG That Predict Localization of Ictal Onset Zone

Clin EEG Neurosci. 2018 May;49(3):206-212. doi: 10.1177/1550059417738688. Epub 2017 Oct 25.


Objective: To assess the utility of simultaneous scalp EEG in patients with focal epilepsy undergoing intracranial EEG evaluation after a detailed presurgical testing, including an inpatient scalp video EEG evaluation.

Methods: Patients who underwent simultaneous scalp and intracranial EEG (SSIEEG) monitoring were classified into group 1 or 2 depending on whether the seizure onset zone was delineated or not. Seizures were analyzed using the following 3 EEG features at the onset of seizures latency, location, and pattern.

Results: The criteria showed at least one of the following features when comparing SSIEEG: prolonged latency, absence of anatomical congruence, lack of concordance of EEG pattern in 11.11% (1/9) of the patients in group 1 and 75 % (3/4) of the patients in group 2. These 3 features were not present in any of the 5 patients who had Engel class I outcome compared with 1 of the 2 patients (50%) who had seizure recurrence after resective surgery. The mean latency of seizure onset in scalp EEG compared with intracranial EEG of patients in group 1 was 17.48 seconds (SD = 16.07) compared with 4.33 seconds (SD = 11.24) in group 2 ( P = .03). None of the seizures recorded in patients in group 1 had a discordant EEG pattern in SSIEEG.

Conclusion: Concordance in EEG features like latency, location, and EEG pattern, at the onset of seizures in SSIEEG is associated with a favorable outcome after epilepsy surgery in patients with intractable focal epilepsy.

Significance: Simultaneous scalp EEG complements intracranial EEG evaluation even after a detailed inpatient scalp video EEG evaluation and could be part of standard intracranial EEG studies in patients with intractable focal epilepsy.

Keywords: EEG; epilepsy; epilepsy surgery; intracranial; scalp; simultaneous.

MeSH terms

  • Adolescent
  • Adult
  • Electroencephalography* / methods
  • Epilepsies, Partial / physiopathology
  • Epilepsies, Partial / surgery*
  • Epilepsy / physiopathology
  • Epilepsy / surgery
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Scalp / physiopathology*
  • Seizures / physiopathology
  • Seizures / surgery*
  • Treatment Outcome
  • Young Adult