The Rolandic mu rhythm: a clinical study of the atypical group.

We studied 241 patients whose electroencephalograms (EEGs) showed 7-13 Hz arch shaped wave patterns (mu rhythm) that are known to appear in the Rolandic area. The patients were then classified into two groups depending on the conditions of appearance of the mu rhythm. Group I (typical group) consisted of 171 cases. In this group, the presence of the wave patterns was not affected by the opening of the eyes, and it was blocked by spontaneous movements, or when sensorimotor stimulation was applied. The characteristic symptoms for this group were observed in patients diagnosed as having well-controlled epilepsy, psychiatric disorders, collagen diseases, etc. In Group I, the peak lay between the ages 6 through 15. Group II (atypical group) consisted of 70 cases. In contrast to Group I, the presence of the wave patterns in this group was reinforced by drowsiness, photic stimulation and hyperventilation. The characteristic symptoms for this group were observed in patients diagnosed as having intractable epilepsy or organic brain disorders. In Group II the peak lay between ages 11 through 15. However, in Group II the cases were almost equally distributed among the various age groups. Paroxysmal abnormal EEG patterns were found to be jointly present with more frequency in the Group II sample of epileptic patients than the Group I sample. Therefore, when the mu rhythm associated with conditions indicating Group II type patients is observed, care must be exercised in the observation of further progression of the illness, and in searching for the possibility of organic brain disorders.     

Diagnostic issues and treatment of cryptogenic or symptomatic generalized epilepsies

To clarify the diagnostic issues and treatment of patients with cryptogenic or symptomatic generalized epilepsies, not including West syndrome (WS), we investigated electroclinical change during the clinical course, and treatment effects in these patients. The selection criteria were minor generalized seizures as their main seizure type and diffuse epileptic discharges as their main EEG findings. Regarding EEG, we included EEGs that predominantly displayed multifocal spike-waves because of the inclusion of severe epilepsy with multiple independent spike foci (SE-MISF). We divided the subjects into two groups according to their main seizure types: Group A (54 patients) with brief tonic seizures and Group B (24 patients) with myoclonic seizures and/or atypical absences. The main epileptic syndromes were considered to be Lennox-Gastaut syndrome and SE-MISF in Group A, and epilepsy with myoclonic-astatic seizures in Group B. A history of WS was often seen in Group A, but it was exceptional in Group B. During the clinical course, seizure types did not basically change in Group A. EEG patterns were changeable in both groups. Although there was some overlap in electroclinical manifestations among epileptic syndromes, a transition between the two groups was not seen. High-dose valproate and ethosuximide were the most effective in Groups A and B, respectively. Long-term prognosis was significantly more favorable in Group B than in Group A.     

Somatic evoked response components and recovery functions in subjects with mu and alpha rhythms.

Subjects with prominent rolandic mu and alpha rhythms showed similar late somatic evoked response (SER) components but different SER recovery functions. A late P5x component was present when SER were superimposed on mu and alpha rhythms spontaneously recorded from the rolandic region of inattentive individuals. Since P5x was not present in other inattentive subjects unless SER were superimposed on a rhythmic rolandic activity evoked by an attentive situation, it seems reasonable to assume that the P5x component is partially due to spontaneous or evoked rolandic EEG rhythmicity. In addition, single propioceptive stimuli produced blocking of mu rhythm and a flat recovery function of the P5a component. In contrast, similar stimuli produced an enhancement of alpha rhythm and a periodic amplitude modulation curve of the P5a component. These results suggest that the P5a component is mediated by the same neurophysiological mechanisms which block or modulate the spontaneous rolandic EEG rhythms.     

300例癫痫及可疑癫痫患者AEEG分析

目的：对３００例癫痫及可疑癫痫患者的动态脑电图的应用价值进行了初步探讨。方法;使用北京明思公司ＳＷ－ＪＨ系列智能化脑电监护仪描记,并与常规脑电图比较。结果：３００例中ＥＥＧ异常５４例,ＡＥＥＧ异常１７８例ＡＥＥＧ痫样放电检出率明显高天ＥＥＧ。１４４例继发性癫痫患者中,ＥＥＧ异常８例,ＡＥＥＧ异常１０例,二者无显著性差异。     

Abnormal Cortical Activation During Planning of Voluntary Movement in Patients with Epilepsy with Focal Motor Seizures: Event-Related Desynchronization Study of Electroencephalographic mu Rhythm

Summary: Purpose: The spatiotemporal distribution of EEG mu rhythm desynchronization was analyzed in patients with partial epilepsy to determine whether frequent focal motor seizures could induce a change of cortical activation during the planning of a voluntary movement.
Methods: The event-related desynchronization (ERD) of the mu rhythm was quantified during a self-paced voluntary movement of the thumb. The results were compared betyeen two groups of patients with epilepsy: in one group (n = 12), the patients had frontal lobe epilepsy with frequent focal motor seizures (FMS); in the second group (n = 12), they had temporal lobe epilepsy (TLE) with complex partial seizures but no ictal movement disorder. The results were also compared with those of control subjects of same age (n = 10).
Results: In the control group, desynchronization of murhythm began over the contralateral central region 2,000 ms before the movement onset. In the FMS group, the desynchronization of mu rhythm was delayed, appearing only 500 ms before the movement onset, and the amplitude of ERD was increased over the frontocentral region. In the TLE group, the spatiotemporal pattern of ERD was the same as in normal subjects, but the amplitude of ERD was increased.
Conclusions: These results indicate that there is a change of reactivity of mu rhythm in patients with partial epilepsy. The change in spatiotemporal pattern of ERD in patients with frequent focal motor seizures suggests that there is an abnormal cortical activation during the planning of a voluntary movement.     

Spasms in clusters in epilepsies other than typical West syndrome.

Although spasms in clusters are one of the major characteristics of West syndrome (WS), there are a significant number of patients who show spasms in clusters but do not fit the standard pattern of WS. It is possible to divide these atypical cases into the following three groups. Group 1: refractory epilepsies beginning in early infancy, associated with atypical electroencephalographic (EEG) features; Group 2: generalized epilepsies with spasms in clusters at ages of 2-3 years or above; and Group 3: localization-related epilepsies with spasms in clusters. Ictal clinical and EEG findings of spasms in clusters in these atypical patients and also those in WS are similar. Patients in Group 1 often suffer from Aicardi syndrome, cortical malformations, early myoclonic encephalopathy and Ohtahara syndrome. Most patients in Group 2 suffer from Lennox-Gastaut syndrome and other generalized epilepsies such as severe epilepsy with multiple independent spike foci. A significant number of them had a history of WS. Small number of patients in Group 2 can be diagnosed as having late-onset WS or long-lasting WS. In Groups 1 and 3 patients, cortical mechanisms play a critical role in their pathophysiology. The presence of older patients with spasms in clusters might indicate not only developing process of the brain but also some selective dysfunction of the brain plays an important role in the occurrence of spasms in clusters. Investigations on these atypical patients can help the understanding of pathophysiological mechanisms of WS and its related epileptic syndromes.     

Benign epilepsy of childhood with rolandic spikes: typical and atypical variants

Clinical course and outcome were compared for 126 children with typical and atypical features of benign epilepsy of childhood with rolandic spikes (BECRS). A retrospective case series design was used, in the setting of a tertiary-care pediatric hospital. The subjects were subdivided into two groups, based on clinical presentation. Group A comprised children with typical features of BECRS (n = 66; 52%) and Group B, those with atypical features (n = 60; 48%). Patients' charts were reviewed for demographic data, family history, comorbid conditions, atypical clinical features, anti-epileptic drugs, and outcome data. Comorbid disorders (e.g., attention deficit hyperactivity disorder, behavioral problems) were slightly more frequent in the atypical group. Overall, there was no difference between the time to become seizure free between the groups: by two years, 41 of 66 in Group A (62%) and 44 of 60 in Group B (71%) were controlled on medication and seizure free. Twenty of the 126 children (16%) required trial of a second anti-epileptic drug: 7 in Group A and 13 in Group B. Resolution of the epilepsy occurred in about the same length of time in both groups (but at different ages, consistent with different age of onset). Both groups had similar long-term outcome.     

Abnormal EEG lateralization in boys with autism.

OBJECTIVE: Functional brain abnormalities associated with autism in 3-8-year-old boys were studied with EEG recorded under controlled experimental condition of sustained visual attention and behavioral stillness. METHODS: EEG was recorded in two independent samples of boys with autism (BWA) from Moscow (N=21) and Gothenburg (N=23) and a corresponding number of age-matched typically developing boys (TDB). EEG spectral power (SP) and SP interhemispheric asymmetry within delta, theta and alpha bands were analyzed. RESULTS: BWA comprised a non-homogeneous group in relation to theta and alpha SP. When four outliers were excluded the only between-group difference in absolute SP was a higher amount of prefrontal delta in BWA. BWA of both samples demonstrated atypical leftward broadband EEG asymmetry with a maximum effect over the mid-temporal regions. Concurrently, the normal leftward asymmetry of mu rhythm was absent in BWA. CONCLUSIONS: The abnormal broadband EEG asymmetry in autism may point to a diminished capacity of right temporal cortex to generate EEG rhythms. The concurrent lack of normal leftward asymmetry of mu rhythm suggests that abnormalities in EEG lateralization in autism may be regionally/functionally specific. SIGNIFICANCE: The data provide evidence for abnormal functional brain lateralization in autism.     

颞叶癫痫发作初期头皮和颅内脑电定位价值的比较研究

目的 比较研究颞叶癫痫发作初期头皮脑电(sEEG)和颅内脑电(iEEG)的特点,探讨有定位意义的EEG指标.方法 常规行长程视频EEG(Video-EEG,V-EEG)监测,以捕捉到3次以上发作为标准.对sEEG难以定位的患者采用颅内埋置硬膜下和(或)深部电极,记录iEEG.结果 本组20例资料显示,sEEG和iEEG的定位检出率分别为50%和100%.经iEEG记录分析,7例sEEG不能定侧者5例完成定侧,10例广泛性sEEG异常者均定位为区域性或局限性表现.结论 低幅快节律、棘波和尖波节律具有重要的的定位价值;80%的sEEG低幅快节律表现者,与iEEG监测中表现一致;80%的sEEG颞叶棘波表现者,在iEEG监测中存在尖波节律.iEEG能明显提高致痫灶的定侧和定位准确性.     

Characterization of the mu rhythm during rapid eye movement sleep.

OBJECTIVE: The rolandic mu rhythm, a resting activity of somatosensory cortex, is a striking feature of the waking human electroencephalogram. This study will demonstrate that activity with identical features occurs during rapid eye movement (REM) sleep. METHODS: Eye and chin leads were added during prolonged closed circuit television (video) electroencephalographic (EEG) recording with scalp (12 patients) or subdural electrodes including 64 contract grids over the frontoparietal cortices (5 patients). Sleep staging was performed by reformatting into standard polysomnography montages (using two EEG channels, and eye and chin channels) and applying standard scoring criteria. The recordings were then reviewed using all EEG channels to assess rhythmic EEG activity by a reader blinded to the sleep staging. RESULTS: During scalp recordings, 7-10 Hz central rhythms were seen during wakefulness in 7 patients, with 6 of these also having similar rhythms during REM sleep. Similar activity was seen over somatosensory cortex during wakefulness and REM in all invasively recorded patients. This activity was blocked by contralateral body movement or contralateral somatosensory stimuli, even during REM sleep. It was absent in other sleep stages. CONCLUSIONS: This REM sleep activity recapitulates all the characteristics of the waking rolandic mu rhythm. This demonstrates functional similarity between the states of wakefulness and REM sleep.     

Ictal hyperperfusion patterns in relation to ictal scalp EEG patterns in patients with unilateral hippocampal sclerosis: a SPECT study

PURPOSE: The aims of the present study were to explore the relation between ictal scalp EEG patterns and ictal hyperperfusion patterns in patients with unilateral hippocampal sclerosis-associated mesial temporal lobe epilepsy (HS-MTLE) by using semiquantitative single-photon emission computed tomography (SPECT) analysis and to assess clinical significance of ictal hyperperfusion patterns. METHODS: We studied retrospectively 39 consecutive patients with surgically proven HS-MTLE. All had both interictal and ictal SPECTs with the tracer injection during a complex partial seizure (CPS) typical of MTLE semiology. According to initial ictal discharge (IID) frequency on scalp EEG, two lateralizing patterns were identified: (a) a sustained regular 5- to 9-Hz rhythm with a restricted temporal or subtemporal distribution (group 1); and (b) an irregular 2- to 5-Hz rhythm with a widespread distribution (group 2). We performed group analysis by using statistical parametric mapping (SPM) of paired ictal-interictal SPECTs to identify regions of significant ictal hyperperfusion and compared clinical characteristics, tracer-injection time, semiology, pathologic HS grade, and surgical outcome between two groups. RESULTS: Of the 39 patients, 19 patients (10 males, nine right HS) were designated as group 1, and the remaining 20 patients (eight males, seven right HS), group 2. Group 1 showed hyperperfusion mainly confined to the ipsilateral temporal lobe, whereas group 2 showed widespread hyperperfusion in the extratemporal structures such as ipsilateral basal ganglia, brainstem, and bilateral thalamus, in addition to the ipsilateral temporal lobe. No significant difference was found between two groups in clinical characteristics, injection time, pathologic HS grade, and surgical outcome. Among semiologic features, dystonic limb posturing was more frequently observed in group 2 (p = 0.006). CONCLUSIONS: Scalp EEG IID frequency in HS-MTLE can be an important determining factor of ictal hyperperfusion patterns. The lack of difference in surgical outcome between two groups implies that different hyperperfusion patterns, according to their IID frequencies, reflect only preferential pathways of ictal propagation rather than intrinsic epileptogenic region.     

Recurrent absence status epilepticus: clinical and EEG characteristics.

In order to outline the clinical and EEG characteristics of recurrent absence status epilepticus (ASE), eight cases with more than two attacks of ASE were studied. Their current ages were between 13 and 84 years, and five of the patients were women. There was a history of epilepsy in five of the patients before the first ASE episode. A varying degree of confusion was the main clinical symptom with associated mild motor signs like perioral, eyelid and generalised myoclonus, seen in one, two and four patients respectively. Two of the patients had juvenile myoclonic epilepsy. One patient had an atypical form of childhood absence epilepsy characterised by recurrent ASE attacks on awakening. There were two patients with phantom absences and late onset generalised convulsions, one patient with perioral myoclonia and absences, and finally two patients with eyelid myoclonia with absences, which are proposed syndromes. On the EEGs that revealed the diagnosis of ASE, there was a marked variability of the generalised multispike and wave discharges. The EEG findings appeared to be syndrome-related with some exceptions. IV Clonazepam lead to a dramatic improvement. Our study shows that the majority of recurrent ASE cases do not fit into the International syndrome classification.     

Clinical stages of progressive myoclonus epilepsy in adult patients

Nineteen hospitalized adult patients with progressive myoclonus epilepsy were studied. According to their clinical status they were divided into three groups of severity. The ages and durations of the disease did not differ significantly between the groups. The groups showed significant differences in ability of daily living, amount of spontaneous myoclonus, IQ and psychomotor reaction time. In EEG the groups differed in respect to the dominant occipital rhythm and amount of myoclonic spikes but not in respect to universal paroxysms. Myoclonic spikes and paroxysms in EEG were only loosely related. The results yield a conclusion that the deterioration caused by the disease is individual and the progression may even cease. In this respect progressive myoclonus epilepsy differs clearly from many hereditary neurometabolic and storage diseases.     

Epilepsy and EEG paroxysmal abnormalities in autism spectrum disorders

The occurrence of epilepsy in autism is variable; nevertheless, EEG paroxysmal abnormalities (PA) are frequently recorded in patients with autism, although the influence of epilepsy and/or EEG PA on the autistic regression has not been clarified yet. We examine a large sample of 345 inpatients with autism, divided into three groups: (1) patients without epilepsy and EEG PA; (2) patients with EEG PA but no seizures; (3) patients with epilepsy including febrile convulsions. The prevalence of epilepsy (24.9%) and EEG PA (45.5%) was higher than that reported in the general population. The significant differences among the three groups concerned autistic regression (comparison between groups 1 and 2, p < 0.05; comparison between groups 1 and 3, p < 0.01), cerebral lesions (comparison between groups 1 and 2, p < 0.05; between groups 1 and 3, p < 0.001), and symptomatic autism (comparison between groups 1 and 2 as much as comparison between groups 1 and 3, p < 0.001), which were prevalent in groups 2 and 3; while severe/profound mental retardation was more frequent in group 3 compared to group 1 (p < 0.01). Focal epilepsy (43.0%) and febrile convulsions (33.7%) were frequent in the third group with epilepsy. EEG PA were mainly localized in temporal and central areas (31.4%). Only 2.6% of patients had subcontinuous/continuous EEG PA during sleep. Seizures and EEG PA were not related to autistic regression. EEG PA occurred mainly in childhood, while epilepsy tended to occur (p < 0.001) as age increased. The age at onset of seizures had two peaks: between 0 and 5 and between 10 and 15 years with no difference between idiopathic and symptomatic cases. In 58.5% of subjects aged ?20 years, epilepsy including febrile seizures occurred at some point of their lives, while cases with only EEG PA were less frequent (9.7%). The relationship among autism, EEG PA and epilepsy should be clarified and investigated. In autism, seizures and EEG PA could represent an epiphenomenon of a cerebral dysfunction independent of apparent lesions.     

Electrocardiographic changes at the onset of epileptic seizures

PURPOSE: We studied heart-rate (HR) changes at the transition from the preictal to the ictal state in patients with focal epilepsies to gain some insight into the mechanisms involved in the neuronal regulation of cardiovascular function. METHODS: We assessed ECG changes during 145 seizures recorded with scalp EEG in 58 patients who underwent video-EEG monitoring. Consecutive RR intervals were analyzed with a newly developed mathematical method for a total of 90 s. RESULTS: Ictal-onset tachycardia occurred in 86.9% of all seizures, whereas bradycardia was documented only in 1.4%. The incidence as well as the amount of ictal HR increase was significantly more pronounced in patients with mesial temporal lobe epilepsy (TLE) as compared with those with non-lesional TLE or extratemporal epilepsy. Moreover, right hemispheric seizures were associated with ictal-onset tachycardia. On average, ictal HR increase preceded EEG seizure onset by 13.7 s in TLE patients and 8.2 s in patients with extratemporal epilepsy. This difference was significant. Ictal HR changes could be classified according to their temporal evolution into two different patterns. These two patterns differed significantly between the temporal lobe and the extratemporal epilepsy patient group. CONCLUSIONS: Epileptic discharges directly influence areas of the central autonomic network, thus regulating HR and rhythm. Such changes occur before ictal discharges appear on surface electrodes. Our newly developed method may be of potential use for clinical applications such as automatic seizure-detection systems. Moreover, our method might help to clarify further the basic mechanisms of interactions between heart and brain.     

Atypical Evolutions of Benign Localization‐Related Epilepsies in Children: Are They Predictable?

PURPOSE: To emphasize that, in some patients, different atypical evolutions occur in the course of so-called benign focal epilepsies of childhood (BFEC) and to promote interest in finding clinical and/or electroencephalographic (EEG) clues to which patients might be prone to these risky evolutions. METHODS: Twenty-six patients who started with the typical clinical and EEG features of benign childhood epilepsy with centrotemporal spikes (BCECTS) but who had reversible or persistent, serious epileptic events including status epilepticus and language, cognitive, or behavioral impairments were followed for 相似文献   

Breach rhythm: the EEG related to skull defects.

From 33 patients with skull defects 89 EEGs were recorded, most with X ray control of the electrode sites. In 10 patients records were made shortly before and about 10 days after bone replacement. The remaining cases had EEGs either with or without bone replacement. The amplitude of alpha and frontal fast rhythms might be increased over or near unilateral posterior and frontal defects respectively. This enhancement was by a factor of less than 3. Since the electrode involved might not be in the defect but on adjacent bone this does not seem to be an effect of greater proximity to the generators. In 21 cases with defects involving or near to electrodes C3(/) and T3(4) sharply focal mu-like rhythms at 6--11 c/sec, usually with faster components, were seen. They formed two groups, at C3(4), responsive to fist clenching and other stimuli (not to eye opening) and at T3(4), unresponsive to any stimulus. In both groups the waves often had spike-like negative phases, but true spikes and also random slow waves with the same restricted focus and responsiveness were sometimes seen. Because of this complexity we prefer the term breach rhythm to mu or mu-like. Bone (or acrylic) replacement abolished central breach rhythm in 3 cases, but not in others and it might or might not restore the symmetry of alpha rhythm or fast rhythm, but burr holes, saw cuts etc., always remain after craniotomy. It is argued that, with the possible exception of 2 patients, the breach rhythms described in this series do not represent enhanced normal mu rhythm. Breach rhythm, even when very spike-like, appears to have little relationship to epilepsy and is not an indicator of recurrence of a tumour.     

Primary motor cortex activation during action observation revealed by wavelet analysis of the EEG.

OBJECTIVE: We characterised the spectral response of the EEG to median nerve stimulation using wavelet analysis, and compared the relative magnitudes of effect of several different action-observation conditions on the beta and mu 'rebound' rhythms. METHODS: EEG responses to median nerve stimulation were recorded from 8 normal adult subjects during baseline or action-observation conditions. Analysis was performed by convolution of the EEG with a family of wavelets. RESULTS: Decreased power in the mu and beta bands characterized the EEG following median nerve stimulation until 500 ms post-stimulus, followed by increased amplitudes ('rebound') of both rhythms. Execution of movement, observation of object-directed movement and observation of somatosensory stimulation all caused a decreased rebound of the beta rhythm whereas observation of aimless thumb movement did not. CONCLUSIONS: Wavelet analysis of the EEG extracted similar features reported in previous studies using bandpass filtering with respect to the activation state of the motor cortex during action observation. Further, our results show that observation of somatosensory stimulation alone is sufficient to cause significant modulation of motor cortex activity. SIGNIFICANCE: These results add further details as to what stimuli can activate the human mirror neuron system and the analytical techniques used may be useful for future studies of clinical populations such as autistic patients.     

学龄儿童病灶性Lennox-Gastaut综合征的临床特征及脑电图

目的分析学龄儿童病灶性Lennox-Gastaut综合征(LGS)的临床特征及脑电图特征,为LGS进一步的临床研究和诊断提供参考。方法选择2011-08—2015-05在我院诊治的LGS学龄儿童32例为LGS组,选择同期在我院进行检查的32例非癫痫正常儿童32例为对照组,记录与调查所有儿童的临床资料、临床表现特征、脑电图特征、智力发育与随访情况等。结果观察组患儿的起病年龄(5.21±2.91)岁;其中8例出生时有异常,8例有惊厥史,9例有癫痫史,6例有智能发育迟滞家族史;强直发作24例,不典型失神11例,肌阵挛发作10例,痉挛发作7例,全面强直-阵挛性癫痫发作21例,失张力发作9例。对照组脑电图均正常,LGS组脑电图背景节律Ⅰ级12例,Ⅱ级16例,Ⅲ级4例;30例清醒或睡眠期可见到12次/s左右的快活动,20例存在一侧性放电波。LGS组智力评分为(61.14±11.84)分,智力障碍发生率为34.4%;对照组智力评分为(34.22±9.93)分,智力障碍发生率为3.1%,组间对比差异有统计学意义(P0.05)。治疗后3个月LGS组的癫痫无发作率为81.3%,6个月无发作率68.8%,1a无发作率为50.0%。结论学龄儿童病灶性LGS的癫痫发作类型多样,脑电图多显示背景ɑ节律异常和棘慢复合波,智能障碍的发生率较高,药物联合治疗的效果较好。     

Extent of neocortical resection and surgical outcome of epilepsy: Intracranial EEG analysis

Purpose: Intracranial electroencephalography (EEG) monitoring is an important process in the presurgical evaluation for epilepsy surgery. The objective of this study was to identify the ideal resection margin in neocortical epilepsy guided by subdural electrodes. For this purpose, we investigated the relationship between the extent of resection guided by subdural electrodes and the outcome of epilepsy surgery. Methods: Intracranial EEG studies were analyzed in 177 consecutive patients who had undergone resective epilepsy surgery. We reviewed various intracranial EEG findings and resection extent. We analyzed the relationships between the surgical outcomes and intracranial EEG factors: the frequency, morphology, and distribution of ictal‐onset discharges, the propagation speed, and the time lag between clinical and intracranial ictal onset. We also investigated whether the extent of resection, including the area showing ictal rhythm and various interictal abnormalities—such as frequent interictal spikes, pathologic delta waves, and paroxysmal fast activity—influenced the surgical outcome. Results: Seventy‐five patients (42%) were seizure free. A seizure‐free outcome was significantly associated with a resection that included the area showing ictal spreading rhythm during the first 3 s or included all the electrodes showing pathologic delta waves or frequent interictal spikes. However, subgroup analysis revealed that the extent of resection did not affect the surgical outcome in lateral temporal lobe epilepsy. Conclusions: The extent of resection is closely associated with surgical outcome, especially in extratemporal lobe epilepsy. Resection that includes the area with total pathologic delta waves and frequent interictal spikes predicts a good surgical outcome.