High-Density EEG in Current Clinical Practice and Opportunities for the Future

Area of Science:

• Neuroscience
• Medical Imaging
• Epileptology

Background:

• Standard 10-20 EEG has limitations in spatial resolution for accurately localizing the epileptogenic cortex.
• High-density EEG (HD-EEG) utilizes a greater number of scalp electrodes for enhanced spatial sampling.
• Widespread adoption of HD-EEG is hindered by cost, setup time, and billing code limitations.

Observation:

• Several institutions have successfully integrated HD-EEG into clinical practice over years.
• HD-EEG has demonstrated utility in diverse clinical scenarios requiring higher spatial resolution.
• Case studies showcase HD-EEG's ability to provide information beyond standard low-density EEG.

Findings:

• HD-EEG improved the lateralization of falsely generalized interictal epileptiform discharges.
• Enhanced localization of epileptic spasms and interictal epileptiform discharges in challenging anatomical regions was achieved.
• HD-EEG facilitated noninvasive localization of seizure onset zones in lesional epilepsy and guided invasive investigations near eloquent cortex.
• Novel techniques using HD-EEG identified epileptic fast oscillations and mapped language cortex.

Implications:

• HD-EEG significantly contributes to the clinical management of epilepsy patients.
• The enhanced spatial resolution of HD-EEG aids in precise localization for surgical planning and diagnosis.
• Further development of HD-EEG techniques may offer future improvements in epilepsy care.