title: Interictal temporal delta activity in temporal lobe epilepsy: correlations with pathology and outcome.
abstract: OBJECTIVE
  To determine the characteristics and the clinical significance of focal slow activity and its association with focal epileptogenesis in patients with temporal lobe epilepsy (TLE).
  
  
  METHODS
  We analyzed the interictal EEGs of 141 patients who had temporal lobe resections for intractable focal seizures and correlated the findings with pathologic changes and outcome. The pathologic changes were categorized into medial temporal sclerosis, tumors, and nonspecific changes.
  
  
  RESULTS
  Lateralized slow activity was found in 66% of the patients, and it was mainly temporal, of delta frequency and irregular morphology. None of its characteristics, including quantity and reactivity to eye opening, was substrate specific. It was highly concordant with temporal spiking (60%), without any difference across the three groups, but provided additional information in 19 (15%) patients who had no lateralizing spikes. The effect of sleep also was similar in all three groups and included transition of slow waves into spikes. Lateralized slow activity to the side of the operation was significantly associated with favorable outcome only in the group with nonspecific pathology (p = 0.008), regardless of the presence, laterality, or topography of spikes.
  
  
  CONCLUSIONS
  Our findings suggest that in patients with TLE whose brain magnetic resonance imaging (MRI) is either normal or suggestive of medial temporal sclerosis, interictal temporal slow activity has a lateralizing value similar to that of temporal spiking. Its association with a favorable outcome in patients with nonspecific pathology also suggests that candidates with lateralizing temporal delta and normal MRI should not be barred from further preoperative assessment.
authors.affiliation: Department of Clinical Neurophysiology, St. Thomas' Hospital, London, UK. michael.koutroumanidis@gstt.sthames.nhs.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Koutroumanidis
authors.forename: Carmen
authors.initials: C
authors.lastname: Martin-Miguel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hennessy
authors.forename: Nozomi
authors.initials: N
authors.lastname: Akanuma
authors.forename: Antonio
authors.initials: A
authors.lastname: Valentin
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Alarcón
authors.forename: Jozef M
authors.initials: JM
authors.lastname: Jarosz
authors.forename: Charles E
authors.initials: CE
authors.lastname: Polkey
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D003700:Delta Rhythm / Q000706:statistics & numerical data*; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012598:Sclerosis; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology*