Ictal EEG Signal Patterns in Focal Epilepsy: Insights into the Localization of the Epileptogenic Zone
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By
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Lingli Hu
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Lingqi Ye
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Hongyi Ye
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Xiaochen Liu
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Kai Xiong
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Yuanming Zhang
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Zhe Zheng
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Hongjie Jiang
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Cong Chen
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Chunhong Shen
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Zhongjin Wang
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Jiping Zhou
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Yingcai Wu
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Kejie Huang
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Junming Zhu
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Zhong Chen
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Meiping Ding
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Shennan Weiss
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Dongping Yang
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Shuang Wang
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January 28, 2026
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Clinical Scorecard: Ictal EEG Signal Patterns in Focal Epilepsy: Insights into the Localization of the Epileptogenic Zone
At a Glance
| Category | Detail |
|---|
| Condition | Focal Epilepsy |
| Key Mechanisms | Dynamic patterns of neuronal synchrony and asynchrony; seizure propagation determined by inter-regional connectivity. |
| Target Population | Patients with drug-resistant focal epilepsy undergoing SEEG evaluation. |
| Care Setting | Epilepsy centers conducting SEEG and resective surgery. |
Key Highlights
- Stereo-EEG (SEEG) is the most precise method for identifying the epileptogenic zone (EZ).
- Ictal EEG patterns exhibit significant heterogeneity, indicating a complex ictal network.
- The harmonic pattern (H pattern) may provide insights into the nonlinear nature of ictal networks.
- Only 50-70% of patients achieve long-term seizure freedom post-surgery.
- Quantitative EEG analysis methods are essential for optimizing EZ localization.
Guideline-Based Recommendations
Diagnosis
- Utilize SEEG for precise localization of the epileptogenic zone.
Management
- Consider resective surgery for patients with drug-resistant focal epilepsy.
Monitoring & Follow-up
- Follow patients for at least 2 years post-surgery to assess outcomes.
Risks
- Limited success rate of surgery with only 50-70% achieving seizure freedom.
Patient & Prescribing Data
Patients with drug-resistant focal epilepsy undergoing SEEG evaluation.
Surgical outcomes assessed using Engel’s classification.
Clinical Best Practices
- Employ quantitative EEG analysis to enhance EZ localization.
- Use a bipolar montage for SEEG electrode review.
- Conduct comprehensive postoperative evaluations with MRI co-registration.
References
