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Addition of Anterior Temporal EEG Electrodes to Improve Seizure Detection

A 28-year-old man was admitted for evaluation of uncontrolled seizures. Continuous video-electroencephalogram (EEG) was recorded with standard 10-20 electrode placement. In addition, anterior temporal electrodes (T1 and T2) were used. Over the first 24 hours, one subclinical and one nonconvulsive electroclinical seizure were recorded from the left anterior temporal region. The subclinical seizure was detected on longitudinal bipolar montages only with the inclusion of T1 and T2 channels (Figure 1). Altered mental status is frequent in the inpatient setting, and electrographic seizures have been reported in approximately 20% of patients undergoing continuous EEG monitoring. Visual analysis with a longitudinal bipolar montage remains the mainstay of video-EEG interpretation. American Clinical Neurophysiology Society guidelines suggest the addition of anterior temporal electrodes to facilitate seizure detection over the underlying temporal regions. However, longitudinal bipolar anterior temporal montages are likely underutilized in standard EEG interpretation. Use of these montages can improve visual detection of subtle temporal seizures with minimal technical or clinical burden, and therefore may lead to more rapid seizure treatment and improvement in neurologic outcomes.