Interictal Epileptiform Discharges

EEG remains the primary technique in the diagnosis, characterization, and localization of partial seizures. This review examines the significance and character of interictal epileptiform abnormailites, periodic lateralized epileptiform discharges, and ictal patterns in patients with partial epilepsy. Interictal epileptiform discharges are common and assist in the diagnosis and localization of partial seizures. Fortunately, true “false positive” EEGs with focal epileptiform abnormalities are distinctly rare. Periodic lateralized discharges have characteristics of both interictal and ictal activity and are an area of controversy as to their clinical significance. Ictal patterns in partial seizures are variable, with the most distinctive features seen in seizures from a mesial temporal lobe origin. The unifying EEG feature of a partial seizure is in its evolution. A partial seizure begins with a clear delineation of the onset of activity that is distinct from the preceding background, followed by an evolution of this activity in both frequency and amplitude and terminating with an identifiable cessation of the rhythmic pattern that merges again into the background activity.