Objective: We investigated whether interictal epileptiform discharges (IED) in the human hippocampus are related to impairment of specific memory processes, and which characteristics of hippocampal IED are most associated with memory dysfunction.Methods: Ten patients had depth electrodes implanted into their hippocampi for preoperative seizure localization. EEG was recorded during 2,070 total trials of a short-term memory task, with memory processing categorized into encoding, maintenance, and retrieval. The influence of hippocampal IED on these processes was analyzed and adjusted to account for individual differences between patients.Results: Hippocampal IED occurring in the memory retrieval period decreased the likelihood of a correct response when they were contralateral to the seizure focus (p , 0.05) or bilateral (p , 0.001). Bilateral IED during the memory maintenance period had a similar effect (p , 0.01), particularly with spike-wave complexes of longer duration (p , 0.01). IED during encoding had no effect, and reaction time was also unaffected by IED.Conclusions: Hippocampal IED in humans may disrupt memory maintenance and retrieval, but not encoding. The particular effects of bilateral IED and those contralateral to the seizure focus may relate to neural compensation in the more functional hemisphere. This study provides biological validity to animal models in the study of IED-related transient cognitive impairment. Moreover, it strengthens the argument that IED may contribute to cognitive impairment in epilepsy depending upon when and where they occur. Neurology â 2013;81:18-24 GLOSSARY CI 5 confidence interval; DMTS 5 delayed-match-to-sample task; GEE 5 generalized estimating equations; IAT 5 intracarotid amobarbital testing; IED 5 interictal epileptiform discharges; OR 5 odds ratio; TLE 5 temporal lobe epilepsy.Temporal lobe epilepsy (TLE) is the most common focal epilepsy in adults, and is associated with memory impairment, 1,2 which affects psychosocial functioning and quality of life. 3 These deficits are attributed to etiologic changes in the hippocampus such as cell death and synaptic reorganization. 4 However, dynamic factors such as interictal abnormalities evident on EEG may impart an independent contribution to neuropsychological outcome.
5Interictal epileptiform discharges (IED) in the cortex, detected with routine scalp EEG recordings, are associated with transient cognitive impairment.6-12 By extension, it is likely that IED in the mesial temporal lobes may affect cognition given the role of these structures in learning and memory. One study 13 showed a 6% decline in working memory performance related to mesial temporal IED. However, as demonstrated in previous studies of cortical IED, 9,10 the degree of cognitive impact could have been underestimated since the authors did not consider 1) the precise timing of the IED within the memory task trials and 2) the specific components involved in memory processing.Using a rodent model of TLE, 14 we recently found that hippocampal IED w...