Component-related BOLD response to localize epileptic focus using simultaneous EEG-fMRI recordings at 3T

Background: Simultaneous EEG-fMRI experiments record spatiotemporal dynamics of epileptic activity. A shortcoming of spike-based EEG-fMRI studies is their inability to provide information about behavior of epileptic generators when no spikes are visible. New method: We extract time series of epileptic components identified on EEG and fit them with Generalized Linear Model (GLM) model. This allows a precise and reliable localization of epileptic foci in addition to predicting generator's behavior. The proposed method works in the source domain and delineates generators considering spatial correlation between spike template and candidate components in addition to patient's medical records. Results: The proposed method was applied on 20 patients with refractory epilepsy and 20 age- and gender matched healthy controls. The identified components were examined statistically and threshold of localization accuracy was determined as 86% based on Receiver Operating Characteristic (ROC) curve analysis. Accuracy, sensitivity, and specificity were found to be 88%, 85%, and 95%, respectively. Contribution of EEG-fMRI and concordance between EEG and fMRI were also evaluated. Concordance was found in 19 patients and contribution in 17. Comparison with existing methods: We compared the proposed method with conventional methods. Our comparisons showed superiority of the proposed method. In particular, when epileptogenic zone was located deep in the brain, the method outperformed existing methods. Conclusions: This study contributes substantially to increasing the yield of EEG-fMRI and presents a realistic estimate of the neural behavior of epileptic generators, to the best of our knowledge, for the first time in the literature.