On the concordance between electrical source imaging, anatomical and functional neuroimaging in patients with focal epilepsy

Objective: Limited knowledge exists regarding how electrical source imaging (ESI) of interictal epileptiform discharges (IEDs) aligns with findings from other neuroimaging modalities. This study investigates the relationships of interictal ESI with MRI, 18FDG PET, SISCOM, and voxel-based morphometry (VBM) during presurgical evaluation of drug-resistant epilepsy (DRE). Methods: A cross-sectional study evaluated the concordance of IED locations from ESI using various inverse solutions (CLARA, LAURA, LORETA, SLORETA, SWLORETA, SSLOFO) with MRI lesions, 18FDG PET, SISCOM, and VBM grey matter abnormalities. The role of ESI in presurgical evaluation of DRE was assessed. Results: Significant relationships were identified between the localization and distribution of IEDs identified by ESI and the various sets of neuroimages. SLORETA and SWLORETA exhibited the highest concordance and interlobar associations with MRI, 18FDG PET and SISCOM. The main cluster of IEDs proved helpful in locating the epileptogenic zone (EZ). Conclusions: The distribution of IEDs identified by the ESI technique exhibited a high degree of significant relationships with other neuroimaging sources. Its use may prove valuable in defining the epileptogenic zone. Significance: Combining ESI of IEDs with other neuroimaging techniques may be useful in the presurgical evaluation of DRE.