Magnetoencephalography and magnetic source imaging in epilepsy

Magnetoencephalograpy (MEG) and Electroencephalography (EEG) provide physicians with complementary data and should not be regarded as mutually exclusive evaluative methods of cerebral activity. Relevant to this edition, MEG applications related to the surgical treatment of epilepsy will be discussed exclusively. Combined MEG/EEG data collection and analysis should be a routine diagnostic practice for patients who are still suffering seizures due to the failure of drug therapy. Clinicians in the field of epilepsy agree that a greater number of patients would benefit from surgery than are currently referred for pre-surgical evaluation. Regardless of age or presumed epilepsy syndrome, all patients deserve the possibility of living seizure-free through surgery. Technological advances in superconducting elements as well as the digital revolution were necessary for the development of MEG into a clinically valuable diagnostic tool. Compared to the examination of electrical activity of the brain, investigation into its magnetic concomitant is a more recent development. In MEG, cerebral magnetic activity is recorded using magnetometer or gradiometer whole-head systems. MEG spikes usually have a shorter duration and a steeper ascending slope than EEG spikes, and variable phase relationships to EEG. When co-registered spikes are compared, it is apparent that EEG and MEG spikes differ. There is agreement among investigators that more interictal epileptiform spikes are seen in MEG than EEG. When MEG is co-registered with invasive intracranial EEG data, the detection rate of interictal epileptiform discharges depends on the number of electrocorticographic channels that record a spike. When patients have a non-localizing video-EEG recording, MEG pinpoints the resected area in 58-72% of the cases.