Focal epileptiform spikes do not show a canonical BOLD response in patients with benign rolandic epilepsy (BECTS)

Simultaneous EEG and functional MRI (EEG-fMRI) studies of focal epileptiform spikes commonly use the canonical haemodynamic response function (HRF) to model the blood-oxygenation-level-dependent (BOLD) response to these events. Support for the use of the canonical HRF has come from large studies that contain mixed cohorts of epilepsy syndromes and discharge types, and has demonstrated plausible epileptic localisation results in the majority of patients. Other studies, however, have reported that some patients show a BOLD response that differs markedly from a canonical HRF. Our aim in this study was to see if the BOLD response is well modelled by a canonical HRF in a homogeneous cohort of patients with benign epilepsy with centrotemporal spikes (BECTS), an idiopathic partial epilepsy with stereotypical centrotemporal spikes on the EEG. We studied eight well-characterised and typical BECTS patients and found that the shape of the average BOLD response was different to the canonical HRF. Furthermore, a localisation analysis using the group-average response provided increased sensitivity and specificity compared to the canonical HRF. Our findings suggest that the canonical HRF may not provide the best model for the BOLD response in some epilepsy syndromes or spike-types. In studies of homogeneous patient groups, therefore, localisation results may be improved by using a group-specific BOLD response.