title: Contribution of EEG/fMRI to the definition of the epileptic focus.
abstract: OBJECTIVE
  To evaluate the clinical relevance of EEG/fMRI in patients with focal epilepsy, by assessing the information it adds to the scalp EEG in the definition of the epileptic focus.
  
  
  METHODS
  Forty-three patients with focal epilepsy were studied with EEG/fMRI using a 3-T scanner. Blood oxygen level-dependent (BOLD) signal changes related to interictal epileptic discharges (IEDs) were classified as concordant or not concordant with the scalp EEG spike field and as contributory if the BOLD signal provided additional information to the scalp EEG about the epileptic focus or not contributory if it did not. We considered patients having intracerebral EEG or a focal lesion on MRI as having independent validation.
  
  
  RESULTS
  Thirty-three patients had at least 3 IEDs during the EEG/fMRI acquisition (active EEG), and all had a BOLD response. In 29 of 33 (88%) patients, the BOLD response was concordant, and in 21 of 33 (64%) patients, the BOLD response was contributory. Fourteen patients had an independent validation: in 12 of these 14, the BOLD responses were validated and in 2 they were invalidated.
  
  
  CONCLUSIONS
  A BOLD response was present in all patients with active EEG, and more specific localization of the epileptic focus was gained from EEG/fMRI in half of the patients who were scanned, when compared with scalp EEG alone. This study demonstrates that EEG/fMRI, in the context of a clinical practice, may contribute to the localization of the interictal epileptic generator in patients with focal epilepsy.
authors.affiliation: Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pittau
authors.forename: François
authors.initials: F
authors.lastname: Dubeau
authors.forename: Jean
authors.initials: J
authors.lastname: Gotman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged