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How Can We Identify Ictal and Interictal Abnormal Activity?

Chapter
First Online:
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 813)

Abstract

The International League Against Epilepsy (ILAE) defined a seizure as “a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.” This definition has been used since the era of Hughlings Jackson, and does not take into account subsequent advances made in epilepsy and neuroscience research. The clinical diagnosis of a seizure is empirical, based upon constellations of certain signs and symptoms, while simultaneously ruling out a list of potential imitators of seizures. Seizures should be delimited in time, but the borders of ictal (during a seizure), interictal (between seizures) and postictal (after a seizure) often are indistinct. EEG recording is potentially very helpful for confirmation, classification and localization. About a half-dozen common EEG patterns are encountered during seizures. Clinicians rely on researchers to answer such questions as why seizures start, spread and stop, whether seizures involve increased synchrony, the extent to which extra-cortical structures are involved, and how to identify the seizure network and at what points interventions are likely to be helpful. Basic scientists have different challenges in use of the word ‘seizure,’ such as distinguishing seizures from normal behavior, which would seem easy but can be very difficult because some rodents have EEG activity during normal behavior that resembles spike-wave discharge or bursts of rhythmic spiking. It is also important to define when a seizure begins and stops so that seizures can be quantified accurately for pre-clinical studies. When asking what causes seizures, the transition to a seizure and differentiating the pre-ictal, ictal and post-ictal state is also important because what occurs before a seizure could be causal and may warrant further investigation for that reason. These and other issues are discussed by three epilepsy researchers with clinical and basic science expertise.

Keywords

Convulsion Convulsive Electroencephalogram Epilepsy Epileptic Focal seizure Epileptiform Seizure-like Spike-wave discharge Theta Sharp wave Behavioral arrest Interictal spike Ictal Pre-ictal Transition to seizure 
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Notes

Acknowledgements

RSF: I first met Phil at Stanford in the early 1970’s, when he brought the hippocampal slice recording technique to the US. Since then, he has been a pioneer and thought leader in so many ways, and a mentor to generations of epilepsy researchers.

MdC: Phil has been a valued colleague and leader in epilepsy research both in the US and internationally.

HES: The three years I spent in Seattle under Phil’s mentorship were some of the most memorable, and important. Long after I left Seattle, his insights and approach to epilepsy research continued to influence my research, and the work of those in my own laboratory.

Other Acknowledgements Section 1.1 was written by RF, Sects. 1.2, 1.3 by MdC and Sect. 1.4 by HES. Supported by The James and Carrie Anderson Fund for Epilepsy Research, The Susan Horngen fund (RF); NIH R01 NS-037562, R01 NS-070173, R21 MH-090606, the Alzheimer’s Association, and the New York State Department of Health (HES); Italian Health Ministry grants RC 2011–2013; RF114-2007 and RF151-2010 (MdC).

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© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordUSA
  2. 2.The Nathan S. Kline Institute for Psychiatric ResearchOrangeburgUSA
  3. 3.Departments of Child & Adolescent Psychiatry, Physiology & Neuroscience, and PsychiatryNew York University Langone Medical CenterNew YorkUSA
  4. 4.Unit of Epileptology and Experimental NeurophysiologyFondazione Istituto Nazionale NeurologicoMilanItaly

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