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PURPOSE High-density EEG (HD-EEG) systems and electrical source imaging techniques have revolutionized our ability to assess the potential sources of epileptiform activity and other EEG features. Nonetheless, clinical use of HD-EEG is hampered by the lack of a standardized electrode nomenclature system and the inherent difficulties encountered in visually reviewing recordings. Inefficient visual review of HD-EEG remains a major barrier to incorporating these techniques into routine clinical care. METHODS Extension of the 10-10 is first defined by the addition of 2 reference curves: the -10% and -20% axial reference curves. Electrode positions over the face are named based on facial bony structures (N = nasion, Z = zygomatic prominence, M = mandible) and over the back of the head on posterior landmarks (I = inion, S = subinion, B = Base). Then, following the 10% incremental distance rule, we define additional electrode positions. Electrodes with nonstandard positions are clustered around the closest 10-10 electrode, deemed their cardinal point. RESULTS The 256-electrode Geodesic Sensor Net mapped to 96 of the 120 extended 10-10 cardinal electrodes. CONCLUSIONS Electrode position nomenclature that builds upon the international standard 10-10 system allows electroencephalographers to identify spatial areas of interest in HD-EEG relative to positions in routine use. A standard viewing montage for HD-EEG and its application with electrical source imaging boost efficiency when reviewing data and improve accuracy in recognizing epileptiform discharges. Additionally, our proposed system is not limited to a specific HD-EEG system, electrode count, or electrode layout.

Introduction High density EEG (hdEEG) systems and Electrical Source Imaging (ESI) techniques have revolutionized our ability to assess the potential sources of epileptiform activity and other EEG features. HdEEG interpretation is limited by lack of standardized electrode position nomenclature and montages. Inefficient visual review of hdEEG remains a major barrier to incorporating these techniques into clinical care. The aim of this project is to propose an electrode map and nomenclature with digitized electrode locations for easy integration with neuroimaging studies and ESI. Methods The 256 channel EEG net (Geodesic Sensor Net, Electrical Geodesics, Inc.) includes electrode locations approximating the International 10–20 and 10–10 systems, but intervening electrodes do not have a standardized location, and many electrodes over the cheeks and face do not have positions defined by the 10–10 or 10–5 systems. We co-registered average 256 channel EEG net electrode positions to the 10–10 positions based on the Montreal Neurologic Institute using Curry 7.0 software. then clustered the 256 electrode locations to their closest 10–10 electrodes tested several channel layouts (montages) allowing rapid transition from global views (all head regions) to focal views (subregions corresponding to 10–10 electrode coordinates). Results 256 electrode locations were successfully clustered around their closest 10–10 electrode, deemed its cardinal point. All 256 electrodes within a cluster received the same initial letters according to the 10–10 electrode at its center. Within a cluster, the first subscript identified its position either anterior (a) or posterior (p) to the cardinal 10–10 electrode. The second subscript identified its position either superior (s) or inferior (i) to the cardinal 10–10 electrode. The last subscript, numerical, identified the proximity of the nonstandard electrode relative to the cardinal 10–10 electrode, compared to the other nonstandard electrodes in that cluster. Therefore, the closest nonstandard electrode would have the subscript as 1, and each subscript would increase in numeric value as distance from the cardinal 10–10 electrode increases. Conclusion Electrode position nomenclature which builds upon the international standard 10–10 system allows electroencephalographers to identify spatial areas of interest in hdEEG relative to positions in routine use. A standard viewing montage for hdEEG and its application with ESI both boosts efficiency when reviewing data, and also improves accuracy in recognizing epileptiform discharges. Furthermore, combining the montage with electrode geopositions will provide greater continuity and ease of use across analysis techniques that would potentially increase adoption of source analysis in clinical care. Our proposed system could also be expanded to higher numbers of electrodes or additional positions on the face or head and is not limited to a specific hdEEG system or electrode count.

Introduction Despite major advances in using high density EEG (hdEEG) and electrical source imaging (ESI) for analysis of interictal activity, research demonstrating its utility in examining ictal activity is still lacking. This may be a result of technical challenges associated with capturing epileptic seizures on scalp hdEEG recordings (physical constraints, such as high number of sensors, lack of standardization in review, comfort, etc.). Furthermore, the value of using interictal discharges as a valid estimate of seizure onset zone (SOZ) still remains disputable. The aim of this study is to use electrical source imaging (ESI) to evaluate the co-localization of ictal and interictal activity through the use of high density scalp EEG. Methods A retrospective analysis was performed on 5 patients with intractable focal temporal and extratemporal lobe epilepsy. EEG scalp recordings were obtained using high density 256 Geodesic Sensory Net (Geodesic Sensor Net, Electrical Geodesic Inc.). ESI was performed using two different commercially available ESI systems, Curry 7.0 (Compumedics) and MIPEGI (Electrical Geodesic Inc.). Sensor locations were determined using the Geodesic Photogrammetry System (GPS) and Geosource 3 (Electrical Geodesic Inc), Realistic geometric individualized head models were constructed from patient specific MRIs using the boundary element model and the finite difference model. Source reconstruction was based on distributed source models and dipole models. The concordance of irritative and ictal onset zones was estimated by the distance between maximal ictal and interictal source activity. Results ESI identified the seizure onset and irritative zones in all 5 patients. There was good concordance between the estimated seizure onset zone and irritative zone on the sub-lobar level. Similar results were obtained through the use of the boundary element and finite difference models. Conclusion The results provide insight into whether interictal discharges provide accurate estimate of SOZ. Furthermore, these results assess similarity of source reconstruction obtained through two different types of individual head models that are commercially available.