Abstract Details

Title Meta-Analysis and Case Review of Clinical, Neuroanatomical, and Electrophysiological Characteristics in Patients Undergoing Simultaneous Scalp and Intracranial EEG (SSIEEG)

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 9-011

Objective

To evaluate the utility of simultaneous scalp and intracranial EEG (SSIEEG) in the evaluation of patients with focal epilepsy.

Background

Scalp and intracranial EEG, along with several imaging modalities, are the standard in identifying seizure onset zones in refractory epilepsy. However, the value of simultaneous scalp and intracranial EEG for localizing seizure onset is not well understood.

Design/Methods We conducted a PRISMA-compliant review of SSIEEG studies on PubMed, Embase, and Google Scholar from inception to September 2024. Data extracted included patient demographics, electrode placements, interictal discharge characteristics (IID), and surgical outcomes. We also present a patient with refractory focal epilepsy who underwent SSIEEG at our institution.

Results Eleven studies involving 238 patients, temporal lobe epilepsy (TLE, 224) and (FLE,14), were analyzed. The results related to seizure onset pattern, onset localization and lateralization, are summarized below (studies, patients). Mesial TLE showed theta/alpha ictal onsets in 75% of cases and delta onsets in 25%, challenging the belief that delta patterns are exclusive to lateral TLE(1,27). SSIEEG showed that temporal (4, 82), mesial/basal frontal (1,14) and insular (1,30) IIDs are detectable on scalp EEG and can be localized by signal processing methods like sLORETA and zero crossing patterns(1,62). SSIEEG accurately lateralized seizure onset in 92.3% of cases compared to 33% contralateral intracranial EEG (cIEEG) in patients undergoing bitemporal IEEG (1,9). Concordance in SSIEEG seizure onset features is linked to favorable surgery outcomes, while discordance may indicate incorrect seizure onset analysis (1/14).

Conclusions

SSIEEG lateralizes and localizes the seizure onset zone, detects mesial/ basal/insural sources, identifies incorrect localization of seizure onset in intracranial EEG electrodes and predicts the outcome of epilepsy surgery. Prospective studies with larger data sets comparing IEEG and SSIEEG are needed to confirm the above findings.

Authors/Disclosures
Diji Johnson, MBBS PRESENTER	Dr. Johnson has nothing to disclose.
Hira Burhan, MD	Dr. Burhan has nothing to disclose.
Rajesh C. Sachdeo, MD	Dr. Sachdeo has nothing to disclose.
Rahul Guha, MD (Jersey Shore University Medical Center)	Dr. Guha has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Experienced Neurology Consulting.
Alexander Buslov, MD	Dr. Buslov has nothing to disclose.
Marina Khrizman, DO (K. Hovnanian Children'S Hospital At Jersey Shore University Medical Center)	Dr. Khrizman has received personal compensation for serving as an employee of Hackensack Meridian Health.
Rachel Penn, MD (Jersey shore medical center)	Dr. Penn has nothing to disclose.
shabbar danish, MD	Dr. danish has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic.
Arun R. Antony, MD (Jersey Shore University Medical Center)	Dr. Antony has nothing to disclose.

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