The necessity for sphenoidal electrodes in the presurgical evaluation of temporal lobe epilepsy: con position.

This article reviews several lines of evidence that efface the requirement for sphenoidal leads in the EEG investigation of temporal lobe epilepsy. Mandibular notch or anterior temporal electrodes, each situated well within the anterior temporal spike field, detect interictal and ictal epileptiform phenomena virtually as well as do sphenoidal leads, provide consistent recording circumstances, do not require physician expertise for their placement, and create no discomfort. This article also cites many studies demonstrating the reliability of ictal semeiology and of MRI in lateralizing and localizing temporal epileptogenesis. Thus, EEG constitutes one element in a matrix of lateralizing data.