Abstracts

Rationale: Wicket spike or rhythm is considered a normal EEG variant of unclear significance although it has been correlated with cerebrovascular disease or migraine. Wickets are recorded in the temporal head regions typically in adults and more commonly during light sleep. Not infrequently do wicket spikes present a challenge to non-epileptologists as they may be difficult to differentiate from epileptiform discharges. Available data regarding this normal variant is based on regular EEGs. We sought to explore wicket spikes and their associated conditions in patients who underwent long-term video-EEG monitoring.Methods: We reviewed long-term video-EEG recordings of 534 patients, 264 (49%) female (newborn-93 year, 35.3±24.3), and 270 (51%) male (newborn-80 year, 21.3±21.7) performed from 2002 to 2007 in a tertiary care academic epilepsy center. Excluding the age group under 18 there were 292 patients, 189 (64%) female (19-93 year, 47.1±18.1), and 103 (36%) male (20-80 year, 45.9±14.8). The recordings were done for both diagnostic purposes and presurgical evaluation. Statistical analysis was done using Chi-square test.Results: Wicket spikes were recorded in 23 patients, 19 (82%) female (26-76 year, 49.8±13.7), 4 (18%) male (23-59 year, 44.5±15.2), monitored for 1-6 days (3.1±1.5). After excluding patients under age 18, the incidence of wickets was 7.8% (23/292). There were 17 (74%) left, 2 (8.7%) right, and 4 (17.4%) bilateral wicket spikes. Only 2 patients had wickets while awake (both on the right), 4 during both wakefulness and light sleep, and 17 only during sleep. Only 1 patient had migraine, 1 had MS and headache, and 1 had dizziness while the remaining 20 (86%) were diagnosed with seizures. Sixteen patients were taking AEDs which were tapered during monitoring. Twelve patients had clinical episodes during monitoring that were not associated with any epileptiform discharges and only 3 patients had true epileptiform activity. Out of 511 non-wicket patients there were 269 patients over age 18, 170 (63%) female (19-93 year, 46.8±18.5), and 99 (37%) male (20-80 year, 46±14.9). There was a significantly higher incidence of wickets in the age group 45-55 (p<0.03). Detailed information was available on 196 patients, 121 female (19-93 year, 46.9±18.1), and 75 male (20-80 year, 46.6±15.2). The diagnoses among these patients included 53 seizures (27%), 11 migraine (6%), 21 headaches (11%), and 6 dizziness (3%). There were no significant differences between wicket and non-wicket groups in terms of these medical conditions, gender, or age. However, there was a significantly higher incidence of diagnosis of seizures in the wicket group (p<0.0004).Conclusions: Our findings indicate 1) a much higher incidence rate for wicket spikes using long term monitoring than previously reported, 2) higher rates of wickets on the left and during sleep, 3) no age or gender differences between the wicket and non-wicket patients, 4) no difference in the incidence of migraine, headaches or dizziness, and 5) significantly higher incidence of misdiagnosis of seizures in patients with wicket spikes.