Power spectrum and intracranial EEG patterns at seizure onset in partial epilepsy

Intracranial electroencephalographic patterns of seizure onset during preoperative assessment with intracerebral and subdural electrodes have been correlated with surgical outcome in 15 patients with partial epilepsy assessed for surgery. The presence and topography of electrodecremental events, high frequency activity, irregular sharp waves intermixed with slow activity, spike-wave activity and rhythmic ictal transformation at seizure onset were studied in a total of 78 complex partial seizures. Raw traces from intracerebral and subdural recordings were assessed visually in conjunction with changes in the following spectral variables (calculated for consecutive 1.28 sec epochs): amplitude (sum of amplitude of all components within a frequency band), activity, mobility, and complexity. The time course of these variables during preictal and ictal periods was displayed and assessed. This technique proved effective for detecting low-amplitude high-frequency activity and subtle electrodecremental events. It was concluded that: (a) most patients (12/15) showed early electrodecremental events, generalised or local, mainly involving frequencies below 40 Hz; (b) generalised electrodecremental events at onset did not imply poor outcome; (c) localised high-frequency activity, between 20 and 80 Hz, was associated with a good outcome.