Revisiting the laterality of wicket spikes with continuous EEG

Wicket spikes (WS) are a benign EEG variant classically defined to be bilateral independent temporal in localization. The authors observed that the majority of WS are exclusively unilateral temporal. The aim was to identify the laterality and clinical significance of the WS.

Epilepsy monitoring unit reports of adult patients were searched for keywords "wicket" or "wickets" and examined for WS lateralization dividing it into three groups: bilateral, left, and right temporal. The age, sex, hand dominance, admission duration, epilepsy risk factors, cerebral microvascular disease, and final diagnosis were also collected.

Wicket spikes were present in 133 studies and were significantly more prevalent in the left temporal region (69%, P < 0.05). Cerebral microvascular disease was more prevalent in patients with left temporal WS (64%, P < 0.05). There were no differences in the remaining studied variables among the three groups. Wicket spikes were not associated with epilepsy.

The authors' findings demonstrate that the majority of WS are strictly left temporal. Despite their predominant unilaterality, WS are not associated with epilepsy but may be associated with cerebral microvascular disease. The authors propose redefining the WS lateralization to be mostly unilateral rather than bilateral. This may prevent misinterpretation of this challenging yet benign EEG variant.