Concordance of Epileptiform Discharges on Video-electroencephalogram (EEG) with the Brain Imaging of Focal Lesions in Drug Resistant Epilepsy: Experience from a Tertiary Centre in India
Sidharth S1, Manjari Tripathi1, Deepti Vibha1, Rajesh Kumar Singh1, Arunmozhimaran Elavarasi1, Jasmine Parihar1, P Sarat Chandra2, Shailesh Gaikwad3, Madhavi Tripathi4
1Neurology, 2Neurosurgery, 3Neuroradiology, 4Nuclear Medicine, All India Institute of Medical Sciences, Delhi, India
Objective:

To determine the concordance and discordance of epileptiform discharges on scalp video EEG and magnetic resonance imaging (MRI) of brain in drug resistant epilepsy (DRE)

Background:
Epilepsy surgery have changed the management of DRE. The principle behind epilepsy surgery is resection or disconnection of the epileptogenic lesion. Video EEG can guide the origin of the seizure foci with brain lesion. The recorded epileptiform discharges may or may not be concordant with the epileptogenic lesion.
Presurgical epileptiform discharges and their concordance with the structural lesion on MRI may guide for selection of candidates for epilepsy surgery with exact delineation of the lesion for resection.
Design/Methods:

Persons with drug resistant focal epilepsy of all age groups who had undergone video EEG for atleast 48 hours and 3T MRI brain imaging with a single focal lesion were taken into this retrospective observational study from 2016 to 2022. MRI lesions were divided as frontal, parietal, temporal, occipital in order to characterize the congruence of epileptiform discharges on video EEG. DRE without MRI lesions, with more than 2 MRI lesions or MRI lesions expanding over 2 or more lobes were excluded from the study.

Results:

1018 DRE person were screened, out of which 278 satisfied the inclusion criteria. 135 with age<18 years & 143 adults (age>18 years). 172 (61.87%) males & 102 (36.69%) females. Out of 278, focal lobar distribution of the lesion was: temporal-184 (66.18%), frontal-62(22.62%),occipital-15(5.39%),parietal-12(4.31%). Statistically significant difference (p<0.05) in concordance of epileptiform discharges was seen maximum with temporal lesions :107/184 (58.15%), frontal-33/62 (53.22%), parietal-4/12 (33.33%), least in occipital lesions :2/15 (13.33%). Concordance was seen more in adults as compared to children with age<6 years in temporal (75% vs 46.15%), frontal (47.6% vs 33%). 

 


Conclusions:

Temporal lesions showed the maximum congruency of video EEG epileptiform discharges with focal lesion on MRI brain.

10.1212/WNL.0000000000204360