Dynamic analysis of fMRI activation during epileptic spikes can help identify the seizure origin

Journal article

Kowalczyk, Magdalena A., Omidvarnia, Amir, Dhollander, Thijs and Jackson, Graeme D.. (2020). Dynamic analysis of fMRI activation during epileptic spikes can help identify the seizure origin. Epilepsia. 61(11), pp. 2558-2571. https://doi.org/10.1111/epi.16695
AuthorsKowalczyk, Magdalena A., Omidvarnia, Amir, Dhollander, Thijs and Jackson, Graeme D.
Abstract

Objective
We use the dynamic electroencephalography–functional magnetic resonance imaging (EEG-fMRI) method to incorporate variability in the amplitude and field of the interictal epileptic discharges (IEDs) into the fMRI analysis. We ask whether IED variability analysis can (a) identify additional activated brain regions during the course of IEDs, not seen in standard analysis; and (b) demonstrate the origin and spread of epileptic activity. We explore whether these functional changes recapitulate the structural connections and propagation of epileptic activity during seizures.

Methods
Seventeen patients with focal epilepsy and at least 30 IEDs of a single type during simultaneous EEG-fMRI were studied. IED variability and EEG source imaging (ESI) analysis extracted time-varying dynamic changes. General linear modeling (GLM) generated static functional maps. Dynamic maps were compared to static functional maps. The dynamic sequence from IED variability was compared to the ESI results. In a subset of patients, we investigated structural connections between active brain regions using diffusion-based fiber tractography.

Results
IED variability distinguished the origin of epileptic activity from its propagation in 15 of 17 (88%) patients. This included two cases where no result was obtained from the standard GLM analysis. In both of these cases, IED variability revealed activation in line with the presumed epileptic focus. Two cases showed no result from either method. Both had very high spike rates associated with dysplasia in the postcentral gyrus. In all 15 cases with dynamic activation, the observed dynamics were concordant with ESI. Fiber tractography identified specific white matter pathways between brain regions that were active at IED onset and propagation.

Significance
Dynamic techniques involving IED variability can provide additional power for EEG-fMRI analysis, compared to standard analysis, revealing additional biologically plausible information in cases with no result from the standard analysis and gives insight into the origin and spread of IEDs.

KeywordsEEG; fibre tractography; fMRI; focal epilepsy; IED variability; source imaging
Year2020
JournalEpilepsia
Journal citation61 (11), pp. 2558-2571
PublisherWiley-Blackwell Publishing, Inc.
ISSN1528-1167
Digital Object Identifier (DOI)https://doi.org/10.1111/epi.16695
Scopus EID2-s2.0-85091256756
Research or scholarlyResearch
Page range2558-2571
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
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All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online21 Sep 2020
Publication process dates
Accepted25 Aug 2020
Deposited03 Jul 2021
Grant IDNHMRC/1060312
NHMRC/1091593
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