Summary:Purpose: We wished to determine whether continuous EEG source imaging can predict the location of seizure onset with sublobar accuracy in temporal lobe epilepsy (TLE).Methods: We retrospectively analyzed the earliest scalp ictal rhythms, recorded with 23-to 27-channel EEG, in 40 patients with intractable TLE. A continuous source analysis technique with multiple fixed dipoles (Focus 1.1) decomposed the EEG into source components representing the activity of major cortical sublobar surfaces. For the temporal lobe, these were basal, anterior tip, anterolateral, and posterolateral cortex. Ictal EEG onset was categorized according to its most prominent and leading source component. All patients underwent intracranial EEG studies before epilepsy surgery, and all had a successful surgical outcome (follow-up >1 year).Results: Most patients with ictal rhythms having a predominant basal source component had hippocampal-onset seizures, whereas those with seizures with prominent lateral source activity had predominantly temporal neocortical seizure origins. Seizures with a prominent anterior temporal tip source component mostly had onset in entorhinal cortex. Seizures in some patients had several equally large and nearly synchronous source components. These seizures, which could be modeled equally well by a single oblique dipole, had onset predominantly in either entorhinal or lateral temporal cortex.
Conclusions:Multiple fixed dipole analysis of scalp EEG can provide information about the origin of temporal lobe seizures that is useful in presurgical planning. In particular, it can reliably distinguish seizures of mesial temporal origin from those of lateral temporal origin. Key Words: Electroencephalography-Dipole-Seizures-Temporal lobe epilepsy.Ictal rhythms are believed to be more reliable than interictal spikes in localizing the epileptogenic focus (1,2). Traditional methods of interpreting scalp ictal EEG have been descriptive and based on the simplistic p i nciple that the electrodes recording the clearest rhythm overlie the seizure focus. Some investigators have noted a correlation among scalp ictal EEG patterns (e.g., frequency and evolution) and intracranial seizure origins in the temporal lobe (3-6). We believe that, as has been shown for interictal spikes (7-15), source analysis of the voltage fields of scalp ictal rhythms can provide more information concerning seizure origin and propagation than can visual inspection of EEG traces.Dipole source modeling is one method of estimating the character of cerebral sources underlying a scalp voltage field (16)(17)(18)(19). This mathematical technique attempts to find a theoretical dipole source that can produce a voltage field on a model head that is equivalent to the