Topographic movie of intracranial ictal high-frequency oscillations with seizure semiology: epileptic network in Jacksonian seizures.
OBJECTIVE
We developed a technique to produce images of dynamic changes in ictal high-frequency oscillations (HFOs) >40 Hz recorded on subdural electroencephalography (EEG) that are time-locked to the ictal EEG and ictal semiology video. We applied this technique to Jacksonian seizures to demonstrate ictal HFO propagation along the homunculus in the primary sensory-motor cortex to visualize the underlying epileptic network.


METHODS
We analyzed intracranial ictal EEGs from two patients with intractable Jacksonian seizures who underwent epilepsy surgery. We calculated the degrees of increase in amplitude within 40-80, 80-200, and 200-300 Hz frequency bands compared to the interictal period and converted them into topographic movies projected onto the brain surface picture. We combined these data with the ictal EEGs and video of the patient demonstrating ictal semiology.


RESULTS
The ictal HFOs began in the sensory cortex and appeared concomitantly with the sensory aura. They then propagated to the motor cortex at the same time that focal motor symptoms evolved. As the seizure progressed, the ictal HFOs spread or reverberated in the rolandic region. However, even when the seizure became secondarily generalized, the ictal HFOs were confined to the rolandic region. In both cases, there was increased amplitude of higher frequency bands during seizure initiation compared to seizure progression.


CONCLUSIONS
This combined movie showed the ictal HFO propagation corresponding to the ictal semiology in Jacksonian seizures and revealed the epileptic network involved in seizure initiation and progression. This method may advance understanding of neural network activities relating to clinical seizure generation and propagation.
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Tomoyuki
T
Akiyama
Derrick W
DW
Chan
Cristina Y
CY
Go
Ayako
A
Ochi
Irene M
IM
Elliott
Elizabeth J
EJ
Donner
Shelly K
SK
Weiss
O Carter
OC
Snead
James T
JT
Rutka
James M
JM
Drake
Hiroshi
H
Otsubo
D000293:Adolescent; D001931:Brain Mapping / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology*; D009415:Nerve Net / Q000503:physiopathology; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology*; D013003:Somatosensory Cortex / Q000503:physiopathology*; D014741:Video Recording / Q000295:instrumentation / Q000379:methods*