Purpose: To determine the validity of scalp-electroencephalography (EEG)-interictal spike (IIS) source localization in posterior cortex epilepsies (PCE).
Methods: Eleven patients with drug-resistant PCE were studied with high-resolution EEG (HR-EEG) and stereoelectroencephalography (SEEG). Sixty-four scalp channels, a realistic head model, and different algorithms [multiple signal classification (MUSIC) and equivalent current dipoles] were used. Results were compared to intracerebral SEEG recordings. For SEEG, a semiautomatic detection of intracerebral IIS was used, allowing a classification of intracerebral IIS into one of three groups: Medial, lateral, and mediolateral.
Results: In the medial group (two patients), scalp-EEG IIS were usually absent for one patient whereas for the other, scalp-EEG was misleading. Indeed, scalp-EEG IIS had a posterior projection, predominantly contralateral to the source. In the lateral group (two patients), scalp-EEG IIS were subcontinuous and accurately localized. In the mediolateral group (seven patients), intracerebral interictal distribution was complex and bilateral for four of seven patients. Source localizations were able to determine only a part, whether lateral or medial, of the intracerebral interictal distribution.
Discussion: The accuracy of scalp-EEG IIS source localization is dependant on the type of intracerebral interictal distribution. In the most frequent type of PCE, patients proved to have a complex interictal distribution between both medial and lateral cortices, and source localizations always underestimated intracerebral IIS. In cases where intracranial sources were quite focal, surface EEG sources were localized with accuracy, even in medial occipital lobe structures.