To determine the concordance and discordance of epileptiform discharges on scalp video EEG and magnetic resonance imaging (MRI) of brain in drug resistant epilepsy (DRE)

Persons with drug resistant focal epilepsy of all age groups who had undergone video EEG for atleast 48 hours and 3T MRI brain imaging with a single focal lesion were taken into this retrospective observational study from 2016 to 2022. MRI lesions were divided as frontal, parietal, temporal, occipital in order to characterize the congruence of epileptiform discharges on video EEG. DRE without MRI lesions, with more than 2 MRI lesions or MRI lesions expanding over 2 or more lobes were excluded from the study.

1018 DRE person were screened, out of which 278 satisfied the inclusion criteria. 135 with age<18 years & 143 adults (age>18 years). 172 (61.87%) males & 102 (36.69%) females. Out of 278, focal lobar distribution of the lesion was: temporal-184 (66.18%), frontal-62(22.62%),occipital-15(5.39%),parietal-12(4.31%). Statistically significant difference (p<0.05) in concordance of epileptiform discharges was seen maximum with temporal lesions :107/184 (58.15%), frontal-33/62 (53.22%), parietal-4/12 (33.33%), least in occipital lesions :2/15 (13.33%). Concordance was seen more in adults as compared to children with age<6 years in temporal (75% vs 46.15%), frontal (47.6% vs 33%). 

Temporal lesions showed the maximum congruency of video EEG epileptiform discharges with focal lesion on MRI brain.