Periodic focal epileptiform discharges

William O. Tatum, Anteneh Feyissa, Karim ReFaey, Sanjeet S. Grewal, Mohammed A. Alvi, Ramiro Castro-Apolo, Grayson Roth, Ivan Segura-Duran, Deependra Mahato, Henry Ruiz-Garcia, Eva Pamias-Portalatin, Kirsten Yelvington, Kaisorn Chaichana, Perry Bechtle, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

Abstract

Objective: To report intraoperative periodic focal epileptiform discharges (PFEDs) during awake craniotomy using high-density electrocorticography (HD-ECoG). Methods: We retrospectively analyzed 81 patients undergoing awake craniotomy between 9/29/2016 and 7/5/2018. Intraoperative HD-ECoG was performed with direct electrocortical stimulation (DECS) for functional brain mapping. Real-time interpretation was performed and compared to scalp EEG when performed. Perioperative seizures, surgical complications, and characteristics of PFEDs were assessed. Results: 69/81 patients (mean age 48.5 years) underwent awake surgery; 55 operated for brain tumor, 11 for epilepsy and 3 for cavernomas. A focal abnormality on brain MRI was present in 63/69 (91.3%) patients. 43/69 (62.3%) patients had seizures preoperatively, 4/69 (5.7%) had seizures during DECS. PFEDs were identified in 11 patients (15.9%); 2 on depth recording and 9 during intraoperative HD-ECoG. 32 patients (46.3%) had preoperative EEG. HD-ECoG detected more epileptiform discharges (EDs) than standard EEG (32/43; 74.4% vs 9/32; 28.1%) (p = <0.001). Of 9/43 patients with PFEDs on HD-ECoG, 7 patients also had scalp EEG but only one case had EDs (p = 0.02), and 0/32 had periodic EDs. Conclusions: Intraoperative PFEDs are novel, highly focal EDs approximating a single gyrus. In patients with brain tumors, PFEDs did not demonstrate a relationship to pre-operative seizures though has similarities to other common waveforms in patients with epilepsy. Significance: PFEDs expand our understanding of the interictal-ictal continuum and highlight improved temporo-spatial information obtained from increasing sensor density during intracranial EEG recording.

Original languageEnglish (US)
Pages (from-to)1320-1328
Number of pages9
JournalClinical Neurophysiology
Volume130
Issue number8
DOIs
StatePublished - Aug 1 2019

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Electroencephalography
Seizures
Craniotomy
Scalp
Brain Neoplasms
Epilepsy
Brain Mapping
Electrocorticography
Stroke
Brain

Keywords

  • Brain tumor
  • Craniotomy
  • Electrocorticography (ECoG)
  • High-density (HD)
  • Periodic focal epileptiform discharges (PFEDs)
  • Periodic lateralized epileptiform discharges (PLEDs)

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Tatum, W. O., Feyissa, A., ReFaey, K., Grewal, S. S., Alvi, M. A., Castro-Apolo, R., ... Quinones-Hinojosa, A. (2019). Periodic focal epileptiform discharges. Clinical Neurophysiology, 130(8), 1320-1328. https://doi.org/10.1016/j.clinph.2019.04.718

Periodic focal epileptiform discharges. / Tatum, William O.; Feyissa, Anteneh; ReFaey, Karim; Grewal, Sanjeet S.; Alvi, Mohammed A.; Castro-Apolo, Ramiro; Roth, Grayson; Segura-Duran, Ivan; Mahato, Deependra; Ruiz-Garcia, Henry; Pamias-Portalatin, Eva; Yelvington, Kirsten; Chaichana, Kaisorn; Bechtle, Perry; Quinones-Hinojosa, Alfredo.

In: Clinical Neurophysiology, Vol. 130, No. 8, 01.08.2019, p. 1320-1328.

Research output: Contribution to journalArticle

Tatum, WO, Feyissa, A, ReFaey, K, Grewal, SS, Alvi, MA, Castro-Apolo, R, Roth, G, Segura-Duran, I, Mahato, D, Ruiz-Garcia, H, Pamias-Portalatin, E, Yelvington, K, Chaichana, K, Bechtle, P & Quinones-Hinojosa, A 2019, 'Periodic focal epileptiform discharges', Clinical Neurophysiology, vol. 130, no. 8, pp. 1320-1328. https://doi.org/10.1016/j.clinph.2019.04.718
Tatum WO, Feyissa A, ReFaey K, Grewal SS, Alvi MA, Castro-Apolo R et al. Periodic focal epileptiform discharges. Clinical Neurophysiology. 2019 Aug 1;130(8):1320-1328. https://doi.org/10.1016/j.clinph.2019.04.718
Tatum, William O. ; Feyissa, Anteneh ; ReFaey, Karim ; Grewal, Sanjeet S. ; Alvi, Mohammed A. ; Castro-Apolo, Ramiro ; Roth, Grayson ; Segura-Duran, Ivan ; Mahato, Deependra ; Ruiz-Garcia, Henry ; Pamias-Portalatin, Eva ; Yelvington, Kirsten ; Chaichana, Kaisorn ; Bechtle, Perry ; Quinones-Hinojosa, Alfredo. / Periodic focal epileptiform discharges. In: Clinical Neurophysiology. 2019 ; Vol. 130, No. 8. pp. 1320-1328.
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abstract = "Objective: To report intraoperative periodic focal epileptiform discharges (PFEDs) during awake craniotomy using high-density electrocorticography (HD-ECoG). Methods: We retrospectively analyzed 81 patients undergoing awake craniotomy between 9/29/2016 and 7/5/2018. Intraoperative HD-ECoG was performed with direct electrocortical stimulation (DECS) for functional brain mapping. Real-time interpretation was performed and compared to scalp EEG when performed. Perioperative seizures, surgical complications, and characteristics of PFEDs were assessed. Results: 69/81 patients (mean age 48.5 years) underwent awake surgery; 55 operated for brain tumor, 11 for epilepsy and 3 for cavernomas. A focal abnormality on brain MRI was present in 63/69 (91.3{\%}) patients. 43/69 (62.3{\%}) patients had seizures preoperatively, 4/69 (5.7{\%}) had seizures during DECS. PFEDs were identified in 11 patients (15.9{\%}); 2 on depth recording and 9 during intraoperative HD-ECoG. 32 patients (46.3{\%}) had preoperative EEG. HD-ECoG detected more epileptiform discharges (EDs) than standard EEG (32/43; 74.4{\%} vs 9/32; 28.1{\%}) (p = <0.001). Of 9/43 patients with PFEDs on HD-ECoG, 7 patients also had scalp EEG but only one case had EDs (p = 0.02), and 0/32 had periodic EDs. Conclusions: Intraoperative PFEDs are novel, highly focal EDs approximating a single gyrus. In patients with brain tumors, PFEDs did not demonstrate a relationship to pre-operative seizures though has similarities to other common waveforms in patients with epilepsy. Significance: PFEDs expand our understanding of the interictal-ictal continuum and highlight improved temporo-spatial information obtained from increasing sensor density during intracranial EEG recording.",
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AU - Feyissa, Anteneh

AU - ReFaey, Karim

AU - Grewal, Sanjeet S.

AU - Alvi, Mohammed A.

AU - Castro-Apolo, Ramiro

AU - Roth, Grayson

AU - Segura-Duran, Ivan

AU - Mahato, Deependra

AU - Ruiz-Garcia, Henry

AU - Pamias-Portalatin, Eva

AU - Yelvington, Kirsten

AU - Chaichana, Kaisorn

AU - Bechtle, Perry

AU - Quinones-Hinojosa, Alfredo

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N2 - Objective: To report intraoperative periodic focal epileptiform discharges (PFEDs) during awake craniotomy using high-density electrocorticography (HD-ECoG). Methods: We retrospectively analyzed 81 patients undergoing awake craniotomy between 9/29/2016 and 7/5/2018. Intraoperative HD-ECoG was performed with direct electrocortical stimulation (DECS) for functional brain mapping. Real-time interpretation was performed and compared to scalp EEG when performed. Perioperative seizures, surgical complications, and characteristics of PFEDs were assessed. Results: 69/81 patients (mean age 48.5 years) underwent awake surgery; 55 operated for brain tumor, 11 for epilepsy and 3 for cavernomas. A focal abnormality on brain MRI was present in 63/69 (91.3%) patients. 43/69 (62.3%) patients had seizures preoperatively, 4/69 (5.7%) had seizures during DECS. PFEDs were identified in 11 patients (15.9%); 2 on depth recording and 9 during intraoperative HD-ECoG. 32 patients (46.3%) had preoperative EEG. HD-ECoG detected more epileptiform discharges (EDs) than standard EEG (32/43; 74.4% vs 9/32; 28.1%) (p = <0.001). Of 9/43 patients with PFEDs on HD-ECoG, 7 patients also had scalp EEG but only one case had EDs (p = 0.02), and 0/32 had periodic EDs. Conclusions: Intraoperative PFEDs are novel, highly focal EDs approximating a single gyrus. In patients with brain tumors, PFEDs did not demonstrate a relationship to pre-operative seizures though has similarities to other common waveforms in patients with epilepsy. Significance: PFEDs expand our understanding of the interictal-ictal continuum and highlight improved temporo-spatial information obtained from increasing sensor density during intracranial EEG recording.

AB - Objective: To report intraoperative periodic focal epileptiform discharges (PFEDs) during awake craniotomy using high-density electrocorticography (HD-ECoG). Methods: We retrospectively analyzed 81 patients undergoing awake craniotomy between 9/29/2016 and 7/5/2018. Intraoperative HD-ECoG was performed with direct electrocortical stimulation (DECS) for functional brain mapping. Real-time interpretation was performed and compared to scalp EEG when performed. Perioperative seizures, surgical complications, and characteristics of PFEDs were assessed. Results: 69/81 patients (mean age 48.5 years) underwent awake surgery; 55 operated for brain tumor, 11 for epilepsy and 3 for cavernomas. A focal abnormality on brain MRI was present in 63/69 (91.3%) patients. 43/69 (62.3%) patients had seizures preoperatively, 4/69 (5.7%) had seizures during DECS. PFEDs were identified in 11 patients (15.9%); 2 on depth recording and 9 during intraoperative HD-ECoG. 32 patients (46.3%) had preoperative EEG. HD-ECoG detected more epileptiform discharges (EDs) than standard EEG (32/43; 74.4% vs 9/32; 28.1%) (p = <0.001). Of 9/43 patients with PFEDs on HD-ECoG, 7 patients also had scalp EEG but only one case had EDs (p = 0.02), and 0/32 had periodic EDs. Conclusions: Intraoperative PFEDs are novel, highly focal EDs approximating a single gyrus. In patients with brain tumors, PFEDs did not demonstrate a relationship to pre-operative seizures though has similarities to other common waveforms in patients with epilepsy. Significance: PFEDs expand our understanding of the interictal-ictal continuum and highlight improved temporo-spatial information obtained from increasing sensor density during intracranial EEG recording.

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KW - Periodic lateralized epileptiform discharges (PLEDs)

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