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Imaging the seizure onset zone with stereo-electroencephalography.

Olivier David 1, * Thomas Blauwblomme 2 Anne-Sophie Job 3 Stéphan Chabardès 4 Dominique M. Hoffmann 5 Lorella Minotti 6, 3 Philippe Kahane 7 
* Corresponding author
1 INSERM U836, équipe 11, Fonctions cérébrales et neuromodulation
GIN - Grenoble Institut des Neurosciences, Clinique Universitaire de Neuroradiologie et Unité IRM, Fonctions Cérébrales et Neuromodulation
4 INSERM U836, équipe 11, Fonctions cérébrales et neuromodulation
GIN - Grenoble Institut des Neurosciences, Fonctions Cérébrales et Neuromodulation, Clinique Universitaire de Neurochirurgie
7 INSERM U836, équipe 9, Dynamique des réseaux synchrones épileptiques
GIN - Grenoble Institut des Neurosciences, IDEE, Laboratoire de Neurophysiopathologie de l'Epilepsie
Abstract : Stereo-electroencephalography is used to localize the seizure onset zone and connected neuronal networks in surgical candidates suffering from intractable focal epilepsy. The concept of an epileptogenicity index has been proposed recently to represent the likelihood of various regions being part of the seizure onset zone. It quantifies low-voltage fast activity, the electrophysiological signature of seizure onset usually assessed visually by neurologists. Here, we revisit epileptogenicity in light of neuroimaging tools such as those provided in statistical parametric mapping software. Our goal is to propose a robust approach, allowing easy exploration of patients' brains in time and space. The procedure is based upon statistical parametric mapping, which is an established framework for comparing multi-dimensional image data that allows one to correct for inherent multiple comparisons. Statistics can also be performed at the group level, between seizures in the same patient or between patients suffering from the same type of epilepsy using normalization of brains to a common anatomic atlas. Results are obtained from three case studies (insular reflex epilepsy, cryptogenic frontal epilepsy and lesional occipital epilepsy) where tailored resection was performed, and from a group of 10 patients suffering from mesial temporal lobe epilepsy. They illustrate the basics of the technique and demonstrate its very good reproducibility and specificity. Most importantly, the proposed approach to the quantification of the seizure onset zone allows one to summarize complex signals in terms of a time-series of statistical parametric maps that can support clinical decisions. Quantitative neuroimaging of stereo-electroencephalographic features of seizures might thus help to provide better pre-surgical assessment of patients undergoing resective surgery.
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Olivier David, Thomas Blauwblomme, Anne-Sophie Job, Stéphan Chabardès, Dominique M. Hoffmann, et al.. Imaging the seizure onset zone with stereo-electroencephalography.. Brain - A Journal of Neurology , Oxford University Press (OUP), 2011, 134 (Pt 10), pp.2898-911. ⟨10.1093/brain/awr238⟩. ⟨inserm-00640161⟩



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