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"Ictal" lateralized periodic discharges.

Indranil Sen-Gupta1, Stephan U Schuele1, Micheal P Macken1

  • 1Feinberg School of Medicine, Northwestern University, 710 N Lakeshore Drive, Chicago, IL 60611, USA.

Epilepsy & Behavior : E&B
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Summary

Lateralized periodic discharges (LPDs) time-locked to symptoms (ILPDs) are strongly associated with central EEG localization. This suggests anatomical location, not clinical salience, differentiates ILPDs from nonictal LPDs (NILPDs).

Keywords:
Continuous EEG monitoringEpilepsia partialis continuaICU EEGIctal–interictal continuumLPDsPLEDsSemiology

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Area of Science:

  • Neurology
  • Clinical Neurophysiology
  • Epileptology

Background:

  • The classification of lateralized periodic discharges (LPDs) as ictal or interictal phenomena is debated.
  • LPDs are often considered ictal when time-locked to clinical symptoms.
  • Investigating the characteristics of "ictal" LPDs (ILPDs) can clarify their definition and utility.

Purpose of the Study:

  • To investigate the characteristics of ILPDs defined by time-locked clinical symptoms.
  • To explore the utility of dichotomizing LPDs into "ictal" and "nonictal" categories based on clinical correlates.

Main Methods:

  • Retrospective review of continuous EEG (cEEG) reports from adult inpatients (2007-2011).
  • Identified LPDs, classifying them as ILPDs (time-locked to symptoms) or NILPDs (lacking clear correlates).
  • Compared neurophysiologic localization, imaging findings, and clinical factors between ILPD and NILPD groups, adjusting for false discovery rate (FDR).

Main Results:

  • Ninety patients had LPDs out of 1452 cEEG monitored patients; 10 met criteria for ILPDs.
  • ILPDs showed a significant association with central head region involvement (OR=11, p=0.018).
  • A trend suggested higher proportion of lesions in the primary sensorimotor cortex for ILPDs (p=0.09).

Conclusions:

  • When defined by time-locked clinical correlates, ILPDs are strongly associated with central EEG localization.
  • This association likely reflects the propensity for cortical irritability in central regions to manifest clinically.
  • Dichotomizing LPDs into ILPDs and NILPDs primarily reflects underlying anatomical differences rather than a clinically salient categorization.