OBJECTIVE: The role of scalp electroencephalogram (EEG) in the preoperative evaluation of epilepsy remains indispensable. This study aims to compare the localization congruence and discrepancies of scalp EEG with surgical resection in pediatric (<18 years) and adult (≥18 years) focal epilepsy, as well as to identify predictors of concordant scalp EEG in both groups. METHODS: A retrospective analysis was performed of preoperative scalp EEG data and postoperative cranial imaging from 454 adults and 140 children with focal epilepsy who underwent surgical resection achieving Engel class I outcomes. RESULTS: In cases of frontal lobe epilepsy, the proportion of concordant interictal EEG was significantly higher in children than adults (54.1% vs. 32%, p = 0.018). Among patients with recorded seizures, concordant ictal EEG was more prevalent in adults than children (67.6% vs. 48.9%, p = 0.003), particularly in temporal lobe epilepsy (TLE) cases (69.9% for adults vs. 51.l% children, p = 0.017). In the pediatric cohort, predictors of concordant interictal EEG included age at seizure onset and TLE; negative predictors were focal to bilateral tonic-clonic seizures (FBTCS) and vascular malformations on MRI. Only concordant interictal EEG emerged as a predictor for concordant ictal EEG. Among adults, TLE was the only predictor for concordant interictal EEG, while female sex was a negative predictor. Age at seizure onset and concordant interictal EEG were positive predictors of concordant ictal EEG, while tumor on MRI was a negative predictor. CONCLUSIONS: The localization of scalp EEG and its predictors varies significantly between pediatric and adult focal epilepsies. These findings should inform personalized preoperative counseling for different age groups.
Zhang et al. (2026) studied this question.