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PT  - JOURNAL ARTICLE
AU  - Hauf, M.
AU  - Jann, K.
AU  - Schindler, K.
AU  - Scheidegger, O.
AU  - Meyer, K.
AU  - Rummel, C.
AU  - Mariani, L.
AU  - Koenig, T.
AU  - Wiest, R.
TI  - Localizing Seizure-Onset Zones in Presurgical Evaluation of Drug-Resistant Epilepsy by Electroencephalography/fMRI: Effectiveness of Alternative Thresholding Strategies
AID  - 10.3174/ajnr.A3052
DP  - 2012 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1818--1824
VI  - 33
IP  - 9
4099  - http://www.ajnr.org/content/33/9/1818.short
4100  - http://www.ajnr.org/content/33/9/1818.full
SO  - Am. J. Neuroradiol.2012 Oct 01; 33
AB  - BACKGROUND AND PURPOSE: Simultaneous EEG/fMRI is an effective noninvasive tool for identifying and localizing the SOZ in patients with focal epilepsy. In this study, we evaluated different thresholding strategies in EEG/fMRI for the assessment of hemodynamic responses to IEDs in the SOZ of drug-resistant epilepsy. MATERIALS AND METHODS: Sixteen patients with focal epilepsy were examined by using simultaneous 92-channel EEG and BOLD fMRI. The temporal fluctuation of epileptiform signals on the EEG was extracted by independent component analysis to predict the hemodynamic responses to the IEDs. We applied 3 different threshold criteria to detect hemodynamic responses within the SOZ: 1) PA, 2) a fixed threshold at P &amp;lt; .05 corrected for multiple comparison (FWE), and 3) FAV (4000 ± 200 activated voxels within the brain). RESULTS: PA identified the SOZ in 9 of 16 patients; FWE resulted in concordant BOLD signal correlates in 11 of 16, and FAV in 13 of 16 patients. Hemodynamic responses were detected within the resected areas in 5 (PA), 6 (FWE), and 8 (FAV) of 10 patients who remained seizure-free after surgery. CONCLUSIONS: EEG/fMRI is a noninvasive tool for the presurgical work-up of patients with epilepsy, which can be performed during seizure-free periods and is complementary to the ictal electroclinical assessment. Our findings suggest that the effectiveness of EEG/fMRI in delineating the SOZ may be further improved by the additional use of alternative analysis strategies such as FAV. BOLDblood oxygen level–dependentEEGelectroencephalographyFAVfixed numbers of activated voxelsFWEfamily-wise errorFWHMfull width at half maximumICindependent componentIEDinterictal epileptic dischargeLTLElateral temporal lobe epilepsyMTLEmesial temporal lobe epilepsyPApeak activationSOZseizure-onset zone