Imag(in)ing seizure propagation: MEG-guided interpretation of epileptic activity from a deep source

Zhong I. Wang, Kazutaka Jin, Yosuke Kakisaka, John C. Mosher, William E. Bingaman, Prakash Kotagal, Richard C. Burgess, Imad M. Najm, Andreas V. Alexopoulos

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Identification and accurate localization of seizure foci is vital in patients with medically-intractable focal epilepsy, who may be candidates for potentially curative resective epilepsy surgery. We present a patient with difficult-to-control seizures associated with an occult focal cortical dysplasia residing within the deeper left parietal operculum and underlying posterior insula, which was not detected by conventional MRI analysis. Propagated activities from this deeper generator produced misleading EEG patterns both on surface and subdural electrode recordings suggesting initial activation of the perirolandic and mesial frontal regions. However, careful spatio-temporal analysis of stereotyped interictal activities recorded during MEG, using sequential dipole modeling, revealed a consistent pattern of epileptic propagation originating from the deeper source and propagating within few milliseconds to the dorsal convexity. In this instance, careful dissection of noninvasive investigations (interictal MEG along with ictal SPECT findings) allowed clinicians to dismiss the inaccurate and misleading findings of the traditional "gold-standard" intracranial EEG. In fact, this multimodal noninvasive approach uncovered a subtle dysplastic lesion, resection of which rendered the patient seizure-free. This case highlights the potential benefits of dynamic analysis of interictal MEG in the appropriate clinical context. Pathways of interictal spike propagation may help elucidate essential neural networks underlying focal epilepsy.

Original languageEnglish
Pages (from-to)2797-2801
Number of pages5
JournalHuman Brain Mapping
Volume33
Issue number12
DOIs
Publication statusPublished - 2012 Dec 1

Keywords

  • Epilepsy
  • ICEEG
  • Interictal spike
  • MEG
  • Magnetoencephalography
  • Nonlesional
  • Propagation

ASJC Scopus subject areas

  • Anatomy
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Clinical Neurology

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  • Cite this

    Wang, Z. I., Jin, K., Kakisaka, Y., Mosher, J. C., Bingaman, W. E., Kotagal, P., Burgess, R. C., Najm, I. M., & Alexopoulos, A. V. (2012). Imag(in)ing seizure propagation: MEG-guided interpretation of epileptic activity from a deep source. Human Brain Mapping, 33(12), 2797-2801. https://doi.org/10.1002/hbm.21401