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Relative Source Power: A novel method for localizing epileptiform EEG discharges.

Michael Scherg1, Reinhard Schulz2, Patrick Berg1

  • 1BESA GmbH, Gräfelfing, Germany.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
|November 17, 2021
PubMed
Summary

Relative Source Power (RSP) imaging accurately localizes extratemporal epileptiform discharges. RSP maps are more precise than voltage maps for epilepsy source estimation, aiding surgical planning.

Keywords:
EEG mappingEpilepsy surgeryExtratemporal lesionsInterictal dischargeSource imagingSource localization

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Area of Science:

  • Neuroscience
  • Epileptology
  • Medical Imaging

Background:

  • Extratemporal focal epilepsy presents diagnostic challenges.
  • Accurate localization of epileptiform discharges is crucial for effective treatment.
  • Existing source imaging methods have limitations in precision.

Purpose of the Study:

  • To validate the accuracy of Relative Source Power (RSP) imaging for extratemporal interictal epileptiform discharges (IEDs).
  • To compare RSP imaging performance against conventional source localization techniques.
  • To assess the utility of RSP in guiding epilepsy surgery.

Main Methods:

  • RSP imaging was applied to patients with extratemporal focal epilepsy and small lesions (<19 cm³).
  • Localization accuracy was assessed by distance to the lesion, concordance with resection, and postoperative outcomes.
  • Performance was compared with voltage maps, equivalent current dipole, and distributed source models.

Main Results:

  • RSP maps correctly localized the epileptogenic lesion in 88% of cases, significantly outperforming voltage maps (p < 0.0026).
  • The median source-to-lesion distance was 9.8 mm, with 98% of sources within a 20 mm radius.
  • Surgical outcomes showed 82.35% sensitivity and 50% specificity, with no significant difference between imaging methods.

Conclusions:

  • RSP imaging offers a rapid, intuitive, and more accurate source estimation compared to voltage maps.
  • RSP demonstrates comparable accuracy to conventional methods at the sublobar level.
  • Defining a 20 mm source region aids in further exploration for extratemporal focal epilepsy.