High-Density EEG in Current Clinical Practice and Opportunities for the Future

Sally M. Stoyell, Janina Wilmskoetter, Mary Ann Dobrota, Dhinakaran M. Chinappen, Leonardo Bonilha, Mark Mintz, Benjamin H. Brinkmann, Susan T. Herman, Jurriaan M. Peters, Serge Vulliemoz, Margitta Seeck, Matti S. Hämäläinen, Catherine J. Chu

Research output: Contribution to journalArticlepeer-review


High-density EEG (HD-EEG) recordings use a higher spatial sampling of scalp electrodes than a standard 10-20 lowdensity EEG montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. Despite these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, using different recording techniques and software, where HD-EEG provided information above and beyond the standard low-density EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: case 1dlateralize falsely generalized interictal epileptiform discharges; case 2dimprove localization of falsely generalized epileptic spasms; cases 3 and 4dimprove localization of interictal epileptiform discharges in anatomic regions below the circumferential limit of standard lowdensity EEG coverage; case 5dimprove noninvasive localization of the seizure onset zone in lesional epilepsy; cases 6 and 7dimprove localization of the seizure onset zone to guide invasive investigation near eloquent cortex; case 8didentify epileptic fast oscillations; and case 9dmap language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.

Original languageEnglish (US)
Pages (from-to)112-123
Number of pages12
JournalJournal of Clinical Neurophysiology
Issue number2
StatePublished - 2021


  • Electrical source imaging
  • Epilepsy
  • HD-EEG
  • Localization
  • Noninvasive
  • Spatial resolution

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)
  • Physiology


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