OBJECTIVE: Some seizures are characterized by a transitional sharp wave (TShW) at ictal onset. We evaluated the clinical significance and localizing value of TShW in partial-onset seizures. METHODS: We identified and analyzed all scalp ictal recordings with a TShW at ictal onset in the Vanderbilt Epilepsy Monitoring Unit over a period of 12 months. RESULTS: A total of 52 ictal discharges in 13 patients started with a TShW. The center of TShW field was concordant with the final localization/lateralization, while that of the subsequent ictal discharge was concordant in only 6 patients. The subsequent rhythmic ictal discharge was non-localizing in 4 patients and misleading in the remaining 3 patients. The final localization was neocortical temporal or frontal in 11 patients, occipito-parietal in one, and undetermined in 1 patient. None of 61 ictal discharges in 15 patients with mesial temporal lobe epilepsy studied in the same time period started with a TShW. CONCLUSION: In this patient series, the TShW was a marker of neocortical seizure onset. The TShW field provided more accurate localization or lateralization of the ictal focus than the following rhythmic ictal discharge. SIGNIFICANCE: TShW at seizure onset should suggest a neocortical rather than hippocampal seizure onset.
OBJECTIVE: Some seizures are characterized by a transitional sharp wave (TShW) at ictal onset. We evaluated the clinical significance and localizing value of TShW in partial-onset seizures. METHODS: We identified and analyzed all scalp ictal recordings with a TShW at ictal onset in the Vanderbilt Epilepsy Monitoring Unit over a period of 12 months. RESULTS: A total of 52 ictal discharges in 13 patients started with a TShW. The center of TShW field was concordant with the final localization/lateralization, while that of the subsequent ictal discharge was concordant in only 6 patients. The subsequent rhythmic ictal discharge was non-localizing in 4 patients and misleading in the remaining 3 patients. The final localization was neocortical temporal or frontal in 11 patients, occipito-parietal in one, and undetermined in 1 patient. None of 61 ictal discharges in 15 patients with mesial temporal lobe epilepsy studied in the same time period started with a TShW. CONCLUSION: In this patient series, the TShW was a marker of neocortical seizure onset. The TShW field provided more accurate localization or lateralization of the ictal focus than the following rhythmic ictal discharge. SIGNIFICANCE: TShW at seizure onset should suggest a neocortical rather than hippocampal seizure onset.
Authors: Hyang Woon Lee; Mark W Youngblood; Pue Farooque; Xiao Han; Stephen Jhun; William C Chen; Irina Goncharova; Kenneth Vives; Dennis D Spencer; Hitten Zaveri; Lawrence J Hirsch; Hal Blumenfeld Journal: Neuroimage Date: 2013-07-11 Impact factor: 6.556
Authors: Beatriz García-López; María Sueiras-Gil; Ana Isabel Gómez-Menéndez; Fernando Vázquez-Sánchez; María Carmen Lloria-Gil; Jerónimo J González-Bernal; Josefa González-Santos; Mirian Santamaría-Pelaéz; Raúl Soto-Cámara; Troels Wesenberg Kjaer Journal: J Clin Med Date: 2021-03-15 Impact factor: 4.241