State-space models of evoked potentials to localize the seizure onset zone

Surgical removal of the seizure onset zone (SOZ) in epilepsy patients is a potentially curative treatment, but the process heavily relies on accurate localization of the SOZ via visual inspection. SPES (Single-pulse electrical stimulation) is a method recently used to explore inter-areal connectivity in vivo to probe functional brain networks such as language and motor networks, and to a much lesser degree, seizure networks. We hypothesized that a dynamical quantification of the connectivity networks derived from the evoked responses induced by SPES could also be used to localize the SOZ. To test our hypothesis, we used an intracranial EEG (iEEG) data set in which five epilepsy patients underwent extensive SPES evaluation. For each patient, and for each dataset that stimulated a different pair of electrodes, we constructed a state-space model from the patient's data. Specifically, we simultaneously estimated model parameters under an exogenous pulse input to a dynamical system whose state vector consisted of the response iEEG signals. Then, the size of the reachable state space, as quantified by the maximum singular value of the reachability matrix, σ_max(R), was computed and denoted as the "largest" network response possible when stimulating the given pair. Our results suggest high agreement between σ_max(R) and clinically annotated SOZ for patients with localizable SOZs.Clinical Relevance- Our study applies dynamical systems theory to identify epileptogenic brain regions, creating a novel tool that clinicians may use in surgical planning for medically-refractory epilepsy patients.