title: Interictal spikes on intracranial recording: behavior, physiology, and implications.
abstract: OBJECTIVE
  The physiological, pathological, and clinical meaning of interictal spikes (IISs) remains controversial. We systematically analyzed the frequency, occurrence, and distribution of IISs recorded from multiple intracranial electrodes in 34 refractory epileptic patients with respect to seizures and antiepileptic drug (AED) changes.
  
  
  METHODS
  Continuous spike counts from all recorded contacts of all implanted electrodes, and also separately for the subset of contacts involved at seizure onset, were tabulated for every hour of every day of recording, and expressed as spikes per hour in six preselected, 24-h intervals (defined to exclude seizures): (1) on medications; (2) prepreseizure; (3) preseizure; (4) postseizure; (5) off meds; and (6) resumed meds. Mean spike rates were analyzed for differences between designated 24-h intervals.
  
  
  RESULTS
  Spike rate in all recorded contacts consistently and significantly decreased after AED withdrawal, despite variability in initial spike rate, diurnal occurrence, seizure character/number/localization of onset, and type(s) of AED continued or withdrawn (p < 0.0001). A significant increase in spike rate was noted in the 24 h after seizures of medial temporal origin, in the medial temporal lobe contacts; neocortical onset seizures did not show any increase.
  
  
  CONCLUSIONS
  These observations confirm and extend previous reports, suggesting a general effect of AED withdrawal, and a more specific effect of medial temporal lobe seizures, on IIS rate. AED mechanisms and efficacy might be demonstrated by quantifying IIS with changes in AEDs. Furthermore, variability in IIS rate after seizures distinguishes localization of seizure onset in medial temporal versus neocortical locations.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520, USA. susan.spencer@yale.edu
authors.forename: Susan S
authors.initials: SS
authors.lastname: Spencer
authors.forename: Irina I
authors.initials: II
authors.lastname: Goncharova
authors.forename: Robert B
authors.initials: RB
authors.lastname: Duckrow
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Novotny
authors.forename: Hitten P
authors.initials: HP
authors.lastname: Zaveri
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003131:Combined Modality Therapy; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000927:Anticonvulsants