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Comparison of depth and subdural electrodes in recording temporal lobe seizures

From the Comprehensive Epilepsy Center (Drs. Sperling and O'Connor), Graduate Hospital, and the Departments of Neurology (Dr. Sperling) and Neurosurgery (Dr. O'Connor), University of Pennsylvania School of Medicine, Philadelphia, PA.

Intracranial EEG recording is often required to identify an area of the brain for resective surgery for intractable epilepsy. We simultaneously compared bilaterally placed depth and limited subdural electrode EEG to determine the most effective method of recording seizures from the temporal lobes. Localized complex partial seizures usually appeared earlier in hippocampal depth electrodes and spread later to subdural recording sites. In 3 patients, hippocampal recordings showed localized seizure origin but subdural recording was nonlocalizing due to rapid bilateral seizure propagation. In 1 patient with nonlocalized seizures presumably of extratemporal origin, subdural electrodes incorrectly lateralized seizure origin to a temporal lobe. Auras and subclinical seizures detected by depth electrode recording were often not evident with subdural electrodes. We conclude that EEG recording with hippocampal depth electrodes correctly identifies and lateralizes temporal lobe seizures more often than with limited subdural electrodes.

Address correspondence and reprint requests to Dr. Sperling, Graduate Hospital, 1 Graduate Plaza, Philadelphia, PA 19146.

Presented in part at the American Epilepsy Society Meeting, San Francisco, CA, October 1988.

Received February 20, 1989. Accepted for publication in final form May 18, 1989.

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