EEG source imaging of epileptic activity at seizure onset.Epilepsy Res 2018; 146:160-171ER
Surgical resection of the seizure onset zone (SOZ) requires that this region of the cortex is accurately localized. The onset of a seizure may be marked by transient discharges, but it also may be accompanied by oscillatory, sinusoidal electrographic activity, such as the EEG theta rhythm. However, because of the superposition of the seizure signal with other electrical signals, including noise artifacts and non-seizure brain activity, noninvasive Electrical Source Imaging (ESI) of the ictal EEG activity at seizure onset remains a challenging task for surgical planning. In the present study, we localize the SOZ from oscillatory features of the EEG at the ictal onset using 256-channel high density electroencephalography (HD-EEG), exact sensor positions, and individual electrical head models constructed from the patient's T1 magnetic resonance image (MRI). Epileptic activities at the seizure onset were characterized with joint time-frequency analysis and source estimated by standardized low resolution electromagnetic tomography (sLORETA) inverse method. The consistency of this localization was examined across multiple seizures for individual patients. For validation, results were compared to three clinical criteria: (1) epileptogenic lesions, (2) seizure onset observed in intracranial EEG, and (3) successful surgical outcomes. In this set of 84 seizures, the onsets of 56 seizures could be localized. For the lateralization measure, the results from HD-EEG with interictal spikes (8/10) and with ictal onset (10/10) were more accurate than international 10-20 EEG for interictal spikes (5/10) and ictal onset (5/10). ESI from HD-EEG with ictal onset (9/10) had greater concordance to the clinical criteria than HD-EEG with interictal spikes (6/10). Noninvasive ESI of oscillatory features at ictal onset using 256-channel HD-EEG and high-resolution individual head models can make a useful contribution to the clinical localization of the SOZ in presurgical planning.