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Author Notes:

Address correspondence to Martha J. Morrell, NeuroPace, Inc., 455 N. Bernardo Ave, Mountain View, CA 94043, U.S.A. E-mail: mmorrell@neuropace.com

Author Emily Mirro certifies that she has equity ownership/stock options with NeuroPace and is an employee of NeuroPace. Author Felice T. Sun certifies that she has equity ownership/stock options with NeuroPace and is a contractor for NeuroPace. Author Martha J. Morrell certifies that she has equity ownership/stock options with NeuroPace and is an employee of NeuroPace. Author Robert Gross certifies that he serves as a consultant to NeuroPace and receives compensation for these services. NeuroPace develops products related to the research described in this paper. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. The remaining authors have no conflicts of interest that are relevant to this research activity. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences & Neurology
  • EEG monitoring
  • Electrocorticography
  • Ambulatory EEG
  • Intracranial EEG
  • Responsive stimulation
  • Localization
  • PARTIAL SEIZURES
  • WITHDRAWAL
  • SURGERY
  • EEG
  • STIMULATION
  • RECURRENCE
  • ADULTS
  • TRIAL
  • BRAIN

Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography

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Journal Title:

Epilepsia

Volume:

Volume 56, Number 6

Publisher:

, Pages 959-967

Type of Work:

Article | Final Publisher PDF

Abstract:

Objective: Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected bilateral MTL epilepsy in order to assess the time required to determine the seizure lateralization and whether this information could influence treatment decisions. Methods: Ambulatory ECoG was reviewed in patients with suspected bilateral MTL epilepsy who were among a larger cohort with intractable epilepsy participating in a randomized controlled trial of responsive neurostimulation. Subjects were implanted with bilateral MTL leads and a cranially implanted neurostimulator programmed to detect abnormal interictal and ictal ECoG activity. ECoG data stored by the neurostimulator were reviewed to determine the lateralization of electrographic seizures and the interval of time until independent bilateral MTL electrographic seizures were recorded. Results: Eighty-two subjects were implanted with bilateral MTL leads and followed for 4.7 years on average (median 4.9 years). Independent bilateral MTL electrographic seizures were recorded in 84%. The average time to record bilateral electrographic seizures in the ambulatory setting was 41.6 days (median 13 days, range 0-376 days). Sixteen percent had only unilateral electrographic seizures after an average of 4.6 years of recording. Significance: About one third of the subjects implanted with bilateral MTL electrodes required >1 month of chronic ambulatory ECoG before the first contralateral MTL electrographic seizure was recorded. Some patients with suspected bilateral MTL seizures had only unilateral electrographic seizures. Chronic ambulatory ECoG in patients with suspected bilateral MTL seizures provides data in a naturalistic setting, may complement data from inpatient video-EEG monitoring, and can contribute to treatment decisions.

Copyright information:

© 2015 Neuropace, Inc. Epilepsia published by Wiley Periodicals on behalf of International League Against Epilepsy.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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