We prospectively compared and correlated interictal spikes recorded with simultaneous surface, sphenoidal, depth and subdural electrodes in 21 patients. Although the amplitude of sphenoidal spikes was often larger than that of surface spikes in patients with mesial basal temporal ictal and interictal foci, only 1 patient had exclusively sphenoidal spikes. Spikes with maximal amplitude at the sphenoidal electrode arose from mesial temporal, temporal neocortical and orbital frontal foci. An inferior vertical temporal dipole (hippocampal positive and inferior temporal neocortex negative) was associated with surface and sphenoidal spikes.