Not surprisingly, this difference was higher if the EEGs contained spikes ( P < 0.001). The individual spike-map occurred more often in the spike-free EEGs of patients compared to EEGs of healthy controls ( P = 0.001). The global explained variance was used to estimate the presence of the spike-maps. We then fitted the spike-map for each patient on their (i) EEG epochs with visible spikes, (ii) epochs without any visible spike and (iii) EEGs of 48 controls. For each patient, we identified typical discharges, calculated their average and the corresponding scalp voltage map (‘spike-map’). For each patient, 6 min of EEG with spikes (yes-spike) and without visually detectable epileptogenic discharges (no-spike) were selected from long-term monitoring recordings (EEG 31–37 channels). Twenty-five patients with pharmacoresistant focal epilepsy were included. In the present study, we set out to determine if EEG voltage maps of epileptogenic activity in individual patients can help to identify disease activity, even if their scalp EEG appears normal. Up to now, there are no other tools than reviewing the seizure diary however, seizures may not be remembered or dismissed voluntarily. Monitoring epileptic activity in the absence of interictal discharges is a major need given the well-established lack of reliability of patients’ reports of their seizures.
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