Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.

Aarhus University Aarhus Denmark

Analytical Neurophysiology Lab Montreal Neurological Institute and Hospital Montreal Québec Canada

Behavioral and Social Neuroscience Research Group Central European Institute of Technology Masaryk University Brno Czechia

Bladin Berkovic Comprehensive Epilepsy Program Department of Neurology Austin Health Melbourne Victoria Australia

Brno Epilepsy Center Department of Neurology St Anne's University Hospital and Medical Faculty of Masaryk University Member of the ERN EpiCARE Brno Czechia

Danish Epilepsy Centre Dianalund Denmark

Department of Clinical Neurosciences CHUV Lausanne University Hospital Lausanne Switzerland

Department of Epileptology University Hospital Bonn Bonn Germany

Department of Neurology Alfred Health Melbourne Victoria Australia

Department of Neurology and Neurosurgery UMC Utrecht Brain Center University Medical Center Utrecht Utrecht the Netherlands

Department of Neurology Duke University Medical Center and Department of Biomedical Engineering Duke Pratt School of Engineering Durham North Carolina USA

Department of Neurology Feinberg School of Medicine Northwestern Memorial Hospital Chicago Illinois USA

Department of Neurology Medical University of Innsbruck Innsbruck Austria

Department of Neurology Royal Melbourne Hospital Melbourne Victoria Australia

Department of Neurology The University of Chicago Chicago Illinois USA

Department of Neurology University of Florida Gainesville Florida USA

Department of Neuroscience Central Clinical School Monash University Melbourne Victoria Australia

Department of Neurosciences Mater Misericordiae Hospital Brisbane Queensland Australia

Department of Paediatrics and Department of Neuroscience Cumming School of Medicine University of Calgary Calgary Alberta Canada

Epilepsy Research Centre Department of Medicine University of Melbourne Melbourne Victoria Australia

Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute University of Calgary Calgary Alberta Canada

Mater Research Institute Faculty of Medicine University of Queensland St Lucia Queensland Australia

Neurophysiology Unit Institute of Neurosurgery Dr Asenjo Santiago Chile

Stichting Epilepsie Instellingen Nederland Heemstede The Netherlands

Wilder Center for Epilepsy Research University of Florida Gainesville Florida USA

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Multicentre analysis of seizure outcome predicted by removal of high-frequency oscillations

Prognostic value of the 5-SENSE Score to predict focality of the seizure-onset zone as assessed by stereoelectroencephalography: a prospective international multicentre validation study