Electric source imaging in temporal lobe epilepsy

The objective of this study was to determine the validity of interictal spike (IIS) source localization in temporal lobe epilepsies (TLE) using stereoelectroencephalography as a validating method. Twenty. patients with drug-resistant TLE were studied with high-resolution EEG and stereoelectroenceplialography. Sixty-four scalp channels, a realistic head model, and different algorithms were used. For each patient, the intracerebral interictal distribution was studied and classified into one of three groups: L (mainly lateral), ML (mediolateral), and M (medial). In group L (three patients), surface IIS were recorded with a high signal-to-noise ratio. Source localizations designated all or part of the intracerebral interictal distribution. In group ML (11 patients), 8 patients had surface IIS, only 5 of which were localizable. High-resolution EEG permitted localization of the more lateral portion and definition of its rostro-caudal extension. A common pattern was identified in three patients with a predominant role of the temporal pole. In group M (six patients), four patients had rare surface IIS, none of which were localizable. Surface EEG does not record IIS limited to medial temporal lobe structures. In TLE with a mediolateral or a lateral interictal distribution, only the lateral component is detectable on Surface EEG and accurately localizable by Source localization tools.