Diagnostic and prognostic value of EEG patterns recorded on foramen ovale and epidural peg electrodes

To describe and assess the significance of EEG characteristics recorded during presurgical video-EEG monitoring (VEM) utilizing foramen ovale (FO) and epidural peg electrodes.

Seizure onset (SOP) and termination pattern morphology and regions, ipsilateral and contralateral latencies, seizure duration, and interictal spike counts were examined in 106 patients (412 seizures). An EEG feature-based logistic regression model predicting one-year post-surgical seizure freedom was assessed using a 5-fold nested cross-validation approach.

Four SOPs and five termination patterns were identified. Seventy-one percent of patients had a single unique SOP, the most common being sharp activity ≤ 13 Hz (28.9% of seizures). Seizures recorded by FO electrodes were associated with SOPs ≤ 13 Hz (OR 1.9, p = .008). Focal-to-bilateral tonic-clonic seizures were associated with SOPs > 13 Hz (p = .04) and bilateral spike and wave termination (p < .001). In patients with temporal lobe epilepsy, logistic regression based prediction of post-surgical outcome had a mean area under the curve of 0.69, with the most important features being SOP, right sided interictal epileptic activity, and contralateral latency.

FO and peg recordings yield characteristic EEG patterns.

EEG features of FO and peg recordings may have diagnostic and prognostic utility in presurgical VEM.