Feasibility of high-density electric source imaging in the presurgical workflow: Effect of number of spikes and automated spike detection

Objective: Presurgical high-density electric source imaging (hdESI) of interictal epileptic discharges (IEDs) is only used by few epilepsy centers. One obstacle is the time-consuming workflow both for recording as well as for visual review. Therefore, we analyzed the effect of (a) an automated IED detection and (b) the number of IEDs on the accuracy of hdESI and time-effectiveness. Methods: In 22 patients with pharmacoresistant focal epilepsy receiving epilepsy surgery (Engel 1) we retrospectively detected IEDs both visually and semi-automatically using the EEG analysis software Persyst in 256-channel EEGs. The amount of IEDs, the Euclidean distance between hdESI maximum and resection zone, and the operator time were compared. Additionally, we evaluated the intra-individual effect of IED quantity on the distance between hdESI maximum of all IEDs and hdESI maximum when only a reduced amount of IEDs were included. Results: There was no significant difference in the number of IEDs between visually versus semi-automatically marked IEDs (74 +/- 56 IEDs/patient vs 116 +/- 115 IEDs/patient). The detection method of the IEDs had no significant effect on the mean distances between resection zone and hdESI maximum (visual: 26.07 +/- 31.12 mm vs semi-automated: 33.6 +/- 34.75 mm). However, the mean time needed to review the full datasets semi-automatically was shorter by 275 +/- 46 min (305 +/- 72 min vs 30 +/- 26 min, P < 0.001).The distance between hdESI of the full versus reduced amount of IEDs of the same patient was smaller than 1 cm when at least a mean of 33 IEDs were analyzed. There was a significantly shorter intraindividual distance between resection zone and hdESI maximum when 30 IEDs were analyzed as compared to the analysis of only 10 IEDs (P < 0.001). Significance: Semi-automatized processing and limiting the amount of IEDs analyzed (similar to 30-40 IEDs per cluster) appear to be time-saving clinical tools to increase the practicability of hdESI in the presurgical work-up.