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Mapping Epileptic Networks Using Simultaneous Intracranial EEG-fMRI.

Umair J Chaudhary1,2,3, Maria Centeno1,2,4, David W Carmichael5

  • 1Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.

Frontiers in Neurology
|October 8, 2021
PubMed
Summary

Simultaneous intracranial EEG-fMRI reveals whole-brain BOLD changes in epilepsy patients. Non-focal interictal epileptiform discharges (IEDs) showed greater concordance with surgical resection and remote brain activity, suggesting broader network involvement.

Keywords:
BOLDEEG-fMRIIED/spikesintracranial EEGpost-surgical outcome

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Area of Science:

  • Neuroscience
  • Medical Imaging
  • Epilepsy Research

Background:

  • Epilepsy surgery requires precise identification of the epileptogenic zone (EZ).
  • Intracranial EEG (icEEG) has limitations in spatial sampling for EZ identification.
  • Simultaneous icEEG-fMRI offers whole-brain exploration of neuronal activity related to interictal epileptiform discharges (IEDs).

Purpose of the Study:

  • To evaluate the utility of simultaneous icEEG-fMRI in mapping brain activity associated with IEDs.
  • To assess the concordance of fMRI BOLD changes with surgical resection volumes.
  • To investigate the distribution of BOLD changes in relation to IED topography and location.

Main Methods:

  • Eight patients with refractory focal epilepsy underwent simultaneous icEEG-fMRI prior to resective surgery.
  • IEDs were classified based on topographic distribution (Focal, Non-focal) and origin (primary IZ1, secondary IZ2).
  • fMRI BOLD changes were analyzed using general linear models and compared with surgical resection volumes and remote brain areas.

Main Results:

  • All IED classes showed associated BOLD changes.
  • BOLD maps were concordant with surgical resection in 71% of IED classes.
  • Non-focal IEDs demonstrated higher concordance (87.5%) with resection volumes and more frequent remote BOLD clusters (93%) compared to focal IEDs.

Conclusions:

  • Simultaneous icEEG-fMRI effectively maps whole-brain BOLD changes for diverse IEDs.
  • Non-focal IEDs are associated with a wider hemodynamic network, including remote brain areas.
  • This technique aids in understanding the extended epileptogenic network beyond the primary seizure onset zone.