High-Density EEG in Current Clinical Practice and Opportunities for the Future. Issue 2 (March 2021)

• Record Type: Journal Article
• Authors: Stoyell, Sally M.; Wilmskoetter, Janina; Dobrota, Mary-Ann; Chinappen, Dhinakaran M.; Bonilha, Leonardo; Mintz, Mark; Brinkmann, Benjamin H.; Herman, Susan T.; Peters, Jurriaan M.; Vulliemoz, Serge; Seeck, Margitta; Hämäläinen, Matti S.; Chu, Catherine J.
• Is Part Of: Journal of clinical neurophysiology. Volume 38:Issue 2(2021)
• Page Start: 112
• Page End: 123
• Publication Date: 2021-03
• Subjects: Electrical source imaging -- Spatial resolution -- HD-EEG -- Noninvasive -- Localization -- Epilepsy; Electroencephalography -- Periodicals; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electroencephalography; Periodicals; 612.805
• DOI: 10.1097/WNP.0000000000000807
• Languages: English
• ISSNs: 0736-0258

Abstract

Summary: High-density EEG (HD-EEG) recordings use a higher spatial sampling of scalp electrodes than a standard 10-20 low-density EEG montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. Despite these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, using different recording techniques and software, where HD-EEG provided information above and beyond the standard low-density EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: case 1—lateralize falsely generalized interictal epileptiform discharges; case 2—improve localization of falsely generalized epileptic spasms; cases 3 and 4—improve localization of interictal epileptiform discharges in anatomic regions below the circumferential limit of standard low-density EEG coverage; case 5—improve noninvasive localization of the seizure onset zone in lesional epilepsy; cases 6 and 7—improve localization of the seizure onset zone to guide invasive investigation near eloquent cortex; case 8—identify epileptic fast oscillations; and case 9—map language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.