Evaluating Invasive EEG Implantations in Medically Refractory Epilepsy with Functional Scalp EEG Recordings and Structural Imaging Data

Seizures in patients with medically refractory epilepsy (MRE) epilepsy cannot be controlled with drugs. For focal MRE, seizures originate in the epileptogenic zone (EZ), which is the minimum amount of cortex that must be treated to be seizure free. Localizing the EZ is often a laborious process wherein clinicians first inspect scalp EEG recordings during several seizure events, and then formulate an implantation plan for subsequent invasive monitoring. The goal of implantation is to place electrodes into the brain region covering the EZ. Then, during invasive monitoring, clinicians visually inspect intracranial EEG recordings to more precisely localize the EZ. The EZ is then surgically removed. Unfortunately surgical success rates average at 50%. Such grim outcomes call for analytical assistance in creating more accurate implantation plans from scalp EEG. In this paper, we introduce a method that combines imaging data (CT and MRI scans) with scalp EEG to derive an implantation distribution. Specifically, scalp EEG data recorded over a seizure event is converted into a time-gamma frequency map, which is then processed to derive a spectrally annotated implantation distribution (SAID). The SAID represents a distribution of gamma power in each of the eight cortical lobe/hemisphere partitions. We applied this method to 4 MRE patients who underwent treatment, and found that the SAID distribution overlapped more with clinical implantations in success cases than in failed cases. These preliminary findings suggest that the SAID may help in improving EZ localization accuracy and surgical outcomes.