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Related Concept Videos

Epilepsy and Seizures: Overview01:24

Epilepsy and Seizures: Overview

Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
Seizures l: Introduction01:20

Seizures l: Introduction

Understanding seizures and epilepsy relies on key definitions that help in recognizing, classifying, and managing these disorders. These definitions provide a framework for recognizing, classifying, and managing seizure disorders.DefinitionsA seizure is a sudden, abnormal burst of electrical activity in the brain that can cause changes in awareness, movement, sensation, or behavior, depending on the area involved. Epilepsy is a chronic condition characterized by recurrent, unprovoked seizures,...

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Related Experiment Video

Updated: May 11, 2026

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients
09:32

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Published on: December 18, 2016

How to establish causality in epilepsy surgery.

Eishi Asano1, Erik C Brown, Csaba Juhász

  • 1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA. eishi@pet.wayne.edu

Brain & Development
|May 21, 2013
PubMed
Summary

Establishing causality for epilepsy surgery requires careful analysis of electro-clinical and neuroimaging data. Comprehensive multimodal assessment, including electroencephalography (EEG) and electrocorticography (ECoG), is crucial for successful patient management.

Keywords:
Concept of the epileptogenic zoneEloquent cortexFunctional brain mappingHigh-frequency oscillations (HFOs)Hill’s criteria for causalityIn-vivo animation of event-related gamma activityInfantile spasmsLanguagePediatric epilepsy surgery

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Area of Science:

  • Neuroscience
  • Epileptology
  • Neurosurgery

Background:

  • Focal findings in epilepsy patients often prompt surgical consideration, but not all are causally linked to seizures.
  • Establishing causality is critical for successful epilepsy surgery outcomes.
  • Scalp video-electroencephalography (EEG) and neuroimaging are standard presurgical tools, but have limitations.

Purpose of the Study:

  • To discuss the application of Hill's criteria for establishing causality in presurgical epilepsy evaluation.
  • To highlight the strengths and limitations of EEG and electrocorticography (ECoG) in determining the epileptogenic zone.
  • To emphasize the need for a comprehensive, multimodal approach to presurgical assessment.

Main Methods:

  • Review of Hill's criteria for causality assessment in epilepsy.
  • Analysis of scalp video-EEG for temporal relationships and ictal discharges.
  • Evaluation of intraoperative/extraoperative electrocorticography (ECoG) for high-frequency oscillations (HFOs) and their relationship to seizure onset and function.

Main Results:

  • Scalp EEG provides temporal correlation but limited spatial resolution; ECoG offers better localization but can be invasive.
  • Resection of seizure onset zones identified by ECoG improves outcomes, but not all patients become seizure-free.
  • High-frequency oscillations (>80Hz) on ECoG correlate with better outcomes, but physiological HFOs can lead to functional loss if resected.

Conclusions:

  • Causality in presurgical epilepsy evaluation is complex and requires integrating data from multiple sources.
  • While EEG and ECoG are vital, their information is limited; a comprehensive assessment is essential.
  • Careful consideration of eloquent cortex, seizure onset zone, and lesions is necessary when interpreting HFOs and planning surgery.