Chronological changes in phase-amplitude coupling during epileptic seizures in temporal lobe epilepsy.

ABSTRACT

OBJECTIVE: To analyze chronological changes in phase-amplitude coupling (PAC) and verify whether PAC analysis can diagnose epileptogenic zones during seizures. METHODS: We analyzed 30 seizures in 10 patients with mesial temporal lobe epilepsy who had ictal discharges with preictal spiking followed by low-voltage fast activity patterns on intracranial electroencephalography. We used the amplitude of two high-frequency bands (ripples 80-200 Hz, fast ripples 200-300 Hz) and the phase of three slow wave bands (0.5-1 Hz, 3-4 Hz, and 4-8 Hz) for modulation index (MI) calculation from 2 minutes before seizure onset to seizure termination. We evaluated the accuracy of epileptogenic zone detection by MI, in which a combination of MI was better for diagnosis and analyzed patterns of chronological changes in MI during seizures. RESULTS: MIRipples/3-4 Hz and MIRipples/4-8 Hz in the hippocampus were significantly higher than those in the peripheral regions from seizure onset. Corresponding to the phase on intracranial electroencephalography, MIRipples/3-4 Hz decreased once and subsequently increased again. MIRipples/4-8 Hz showed continuously high values. CONCLUSIONS: Continuous measurement of MIRipples/3-4 Hz and MIRipples/4-8 Hz could help identify epileptogenic zones. SIGNIFICANCE: PAC analysis of ictal epileptic discharges can help epileptogenic zone identification.