Usefulness of Intravascular EEG : an Intracranial EEG Recording from Intravascular Electrodes in the Patient of Temporal Lobe Epilepsy

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We performed EEG with intravascular electrodes (intravascular EEG) as a presurgical extracranial study during the Wada procedure to detect the epileptiform discharges originating specifically from the temporal lobe(TLE). In this study of nine patients with temporal lobe epilepsy, we evaluated the usefulness of this technique for comparison with a simultaneously recorded scalp EEG, furthermore with the results of chronic intracranial EEG recordings.The subjects in this study were 9 patients with medically intractable TLE. After giving informed consent, we placed intravascular electrodes into bilateral middle meningeal artery at the level of the for amen spinosum, placing the electrodes to the inferior surface of each temporal lobe. The intravascular EEG was recorded for about one hour while scalp EEG with sphenoidal (SP) electrodes was simultaneously recorded.The intravascular EEG demonstrated clear epileptiform discharges, sometimes even when they were absent on the simultaneously reco … More rded scalp EEG. As for the lateralization of the epileptiform discharges recorded from intravascular EEGs, in 6 of 9 patients, the epileptiform discharges were observed only at the unilateral intravascular electrode which lateralization was agreed with that of the ictal patterns obtained from subsequent intracranial recordings. In 2 patients, although epileptiform discharges were demonstrated bilaterally, most of the epileptiform discharges were predominantly observed at the unilateral intravascular electrode. In the remaining 1 case intravascular EEG revealed bilateral epileptiform discharges, however, the ictal patterns from intracranial EEG also showed bilaterally. The intravascular EEG agreed with lateralization of epileptiform discharges obtained from subsequent intracranial recordings.This intravascular EEG can detect the epileptiform discharges more sensitive than SP electrode. Although the duration of recording is limited, intravascular EEG appears to be useful because it can be performed easily, safely and relatively painlessly in the course of angiography. Less