Neuron
Volume 30, Issue 1, April 2001, Pages 51-64
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Clinical study
Epileptic Seizures May Begin Hours in Advance of Clinical Onset: A Report of Five Patients

https://doi.org/10.1016/S0896-6273(01)00262-8Get rights and content
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Abstract

Mechanisms underlying seizure generation are traditionally thought to act over seconds to minutes before clinical seizure onset. We analyzed continuous 3- to 14-day intracranial EEG recordings from five patients with mesial temporal lobe epilepsy obtained during evaluation for epilepsy surgery. We found localized quantitative EEG changes identifying prolonged bursts of complex epileptiform discharges that became more prevalent 7 hr before seizures and highly localized subclinical seizure-like activity that became more frequent 2 hr prior to seizure onset. Accumulated energy increased in the 50 min before seizure onset, compared to baseline. These observations, from a small number of patients, suggest that epileptic seizures may begin as a cascade of electrophysiological events that evolve over hours and that quantitative measures of preseizure electrical activity could possibly be used to predict seizures far in advance of clinical onset.

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Present Address: Chicago Institute of Neurosurgery and Neuroresearch, Department of Neurosurgery, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Jelke, Suite 1491, Chicago, Illinois 60612.