Ictal localization by source analysis of infraslow activity in DC-coupled scalp EEG recordings

New bedside long-term DC-coupled EEG techniques have demonstrated that infraslow (<0.5 Hz) activity lateralizes temporal lobe seizures (Vanhatalo, S., Holmes, M.D., Tallgren, P., Voipio, J., Kaila, K., Miller, J.W., 2003a. Very slow EEG responses indicate the laterality of temporal lobe seizures: a DC-EEG study. Neurology 60, 1098-1104). However, even high amplitude infraslow activity is difficult to localize by simple visual inspection if there is overlying faster EEG activity or slow artifact. In this study, we address this with improved DC-coupled EEG recording and analysis techniques and also extend observation to both temporal and extratemporal seizures. Recordings were performed during presurgical evaluation of medically intractable epilepsy, with 20 seizures in 11 patients analyzed. A commercial DC-coupled recording device was used, with sintered Ag/AgCl electrodes in a standard 10-10 system array, with additional anterior temporal and subtemporal electrodes. Seizures were localized with a software package by means of source montage analysis. Infraslow signals occurred with all seizures, often with amplitude orders of magnitude higher than conventional frequencies (0.5 to 70 Hz). The most reliable method to localize these signals and distinguish them from artifacts used a source montage after low-pass filtering below 0.5 Hz. Five of the eight patients who received epilepsy surgery had follow-up documenting significant seizure reduction, and infraslow signal analysis correctly localized the region of seizure onset in all five, while conventional noninvasive EEG recording and analysis localized only three of the five. Several seizures were also analyzed using principle component analysis source localization methods, with the results less consistently localizing than source montage analysis. DC-coupled EEG recordings give clinically useful information to noninvasively localize the seizure focus. The value of this method is increased by source analysis tools that reveal localized changes more clearly than direct visual inspection.