Document Detail

Transitional sharp waves at ictal onset--a neocortical ictal pattern.
MedLine Citation:
PMID:  19264545     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Some seizures are characterized by a transitional sharp wave (TShW) at ictal onset. We evaluated the clinical significance and localizing value of TShW in partial-onset seizures. METHODS: We identified and analyzed all scalp ictal recordings with a TShW at ictal onset in the Vanderbilt Epilepsy Monitoring Unit over a period of 12 months. RESULTS: A total of 52 ictal discharges in 13 patients started with a TShW. The center of TShW field was concordant with the final localization/lateralization, while that of the subsequent ictal discharge was concordant in only 6 patients. The subsequent rhythmic ictal discharge was non-localizing in 4 patients and misleading in the remaining 3 patients. The final localization was neocortical temporal or frontal in 11 patients, occipito-parietal in one, and undetermined in 1 patient. None of 61 ictal discharges in 15 patients with mesial temporal lobe epilepsy studied in the same time period started with a TShW. CONCLUSION: In this patient series, the TShW was a marker of neocortical seizure onset. The TShW field provided more accurate localization or lateralization of the ictal focus than the following rhythmic ictal discharge. SIGNIFICANCE: TShW at seizure onset should suggest a neocortical rather than hippocampal seizure onset.
Nabil J Azar; Andre H Lagrange; Bassel W Abou-Khalil
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Publication Detail:
Type:  Journal Article     Date:  2009-03-04
Journal Detail:
Title:  Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology     Volume:  120     ISSN:  1872-8952     ISO Abbreviation:  Clin Neurophysiol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-10     Completed Date:  2009-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883319     Medline TA:  Clin Neurophysiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  665-72     Citation Subset:  IM    
Neurology Department, Vanderbilt University Medical Center, A-0118 MCN 2551, Nashville, TN 37232-2551, USA.
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MeSH Terms
Brain Mapping
Electroencephalography / methods
Epilepsies, Partial / physiopathology*,  radionuclide imaging,  surgery
Magnetic Resonance Imaging / methods
Middle Aged
Neocortex / physiopathology*,  radionuclide imaging,  surgery
Retrospective Studies
Signal Processing, Computer-Assisted*
Tomography, Emission-Computed, Single-Photon / methods
Young Adult

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