Postictal electroencephalographic (EEG) suppression: A stereo ‐EEG study of 100 focal to bilateral tonic–clonic seizures

SummaryObjectivesWe aimed to describe intracerebral aspects of postictal generalized electroencephalography suppression (PGES) following focal to bilateral tonic –clonic (“secondarily generalized tonic–clonic”) seizures (GTCS) recorded using stereoelectroencephalographic (SEEG), and to correlate these with electroclinical features.MethodsThree independent observers scored semiologic and SEEG features. Patient and epilepsy characteristics were collected. Descriptive statistics and multivariate analysis were performed. The operational definition of PGES on SEEG used strict criteria (absence of visible signal at 20  μV/mm amplitude, in all readable channels). Postictal regional suppression (RS) was identified if only a subset of implanted electrodes showed absence of signal.ResultsWe evaluated 100 seizures in 52 patients. Interobserver agreement was good ( κ 0.72 for clinical features and 0.73 for EEG features). PGES was present in 27 of 100 and RS without PGES present in 42 of 100 seizures. Region of RS included epileptogenic zone in 43 of 51 (86%). No effect of sampling (multilobar or bilateral exploration) was seen. Oral tonicity (mouth opening an d/or tonic vocalization during the tonic phase of GTCS) was associated with the presence of PGES (P = 0.029; negative predictive value [NPV] 0.91). Bilateral upper limb extension during the tonic phase correlated with PGES (P = 0.041; NPV 0.85). Association of both oral tonicity and bilateral upper limb extension had ...

Source: Epilepsia - November 22, 2018 Category: Neurology Authors: Angela Marchi, Bernard Giusiano, Mark King, Stanislas Lagarde, Agn ès Trébuchon‐Dafonseca, Christophe Bernard, Sylvain Rheims, Fabrice Bartolomei, Aileen McGonigal Tags: FULL ‐LENGTH ORIGINAL RESEARCH Source Type: research