Spikes and Seizures: Remote Relatives

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Presentation transcript:

Spikes and Seizures: Remote Relatives Jean Gotman, PhD Montreal Neurological Institute McGill University Spikes are often not a good spatial indicator of the region of seizure onset and their temporal fluctuations tell us nothing about the likelihood of seizure occurrence.

Spikes and seizures do not always occur at the same place It is common that spikes and seizures originate in the same place in focal epilepsy It is frequent that spikes occur in the same general region but not exactly in the same place as seizures It also occurs that spikes and seizures occur in very different regions (e.g. bitemporal spikes, unitemporal seizures).

Spikes primarily in hippocampus and first temporal gyrus (absent from amygdala) Seizure primarily in hippocampus and amygdala

Spikes primarily left fronto-temporal Seizure left occipital

Tyvaert et al, Brain, 2008 Interictal Ictal BOLD increase involves the dysplastic lesion in the spikes and seizures. Activation during the seizure is larger in the dysplasia and spreads to connected areas. Tyvaert et al, Brain, 2008

Interictal Ictal Nodular heterotopia is involved in the BOLD increase only during interictal events. Overlying cortex is involved at the time of seizure generation.

Spikes and seizures do not fluctuate in parallel over time Reduction in antiepileptic medication Increase in seizure frequency No change in spiking rate Increase in spiking rate following seizures; no change before seizures.

Spiking Rate and AED Withdrawal Gotman and Marciani, Annals Neurology, 1985

Spiking Rate, AED Withdrawal and Seizure Occurrence

Spencer et al Epilepsia, 2008

Conclusion There is abnormal brain tissue This tissue generates seizures, the phenomenon we are primarily interested in This tissue also generates spikes; just because we are interested in seizures does not imply that spikes should be a good indicator of seizure generation. It appears that they are two phenomena, with a few links but many differences (HFOs are more closely related to seizures than spikes are).

Left centroparietal spikes and brief electrical seizure recorded in a patient with a left parietal dysplasia.

Right posterior temporal spikes and brief electrical seizure recorded in a patient with a large right periventricular heterotopia.

Spiking Rate and AED Withdrawal