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Vaudano AE, Avanzini P, Tassi L, et al. Causality within the Epileptic Network: An EEG-fMRI Study Validated by Intracranial EEG. Front Neurol. 2013;4:185doi: 10.3389/fneur.2013.00185.
Vaudano, A. E., Avanzini, P., Tassi, L., Ruggieri, A., Cantalupo, G., Benuzzi, F., Nichelli, P., Lemieux, L., & Meletti, S. (2013). Causality within the Epileptic Network: An EEG-fMRI Study Validated by Intracranial EEG. Frontiers in neurology, 4185. https://doi.org/10.3389/fneur.2013.00185
Vaudano, Anna Elisabetta, et al. "Causality within the Epileptic Network: An EEG-fMRI Study Validated by Intracranial EEG." Frontiers in neurology vol. 4 (2013): 185. doi: https://doi.org/10.3389/fneur.2013.00185
Vaudano AE, Avanzini P, Tassi L, Ruggieri A, Cantalupo G, Benuzzi F, Nichelli P, Lemieux L, Meletti S. Causality within the Epileptic Network: An EEG-fMRI Study Validated by Intracranial EEG. Front Neurol. 2013 Nov 14;4:185. doi: 10.3389/fneur.2013.00185. eCollection 2013. PMID: 24294210; PMCID: PMC3827676.
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Front Neurol. 2013 Nov 14;4:185. doi: 10.3389/fneur.2013.00185. eCollection 2013.

Causality within the Epileptic Network: An EEG-fMRI Study Validated by Intracranial EEG.

Frontiers in neurology

Anna Elisabetta Vaudano, Pietro Avanzini, Laura Tassi, Andrea Ruggieri, Gaetano Cantalupo, Francesca Benuzzi, Paolo Nichelli, Louis Lemieux, Stefano Meletti

Affiliations

  1. Department of Biomedical Sciences, Metabolism, and Neuroscience, NOCSE Hospital, University of Modena and Reggio Emilia , Modena , Italy ; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK.

PMID: 24294210 PMCID: PMC3827676 DOI: 10.3389/fneur.2013.00185

Abstract

Accurate localization of the Seizure Onset Zone (SOZ) is crucial in patients with drug-resistance focal epilepsy. EEG with fMRI recording (EEG-fMRI) has been proposed as a complementary non-invasive tool, which can give useful additional information in the pre-surgical work-up. However, fMRI maps related to interictal epileptiform activities (IED) often show multiple regions of signal change, or "networks," rather than highly focal ones. Effective connectivity approaches like Dynamic Causal Modeling (DCM) applied to fMRI data potentially offers a framework to address which brain regions drives the generation of seizures and IED within an epileptic network. Here, we present a first attempt to validate DCM on EEG-fMRI data in one patient affected by frontal lobe epilepsy. Pre-surgical EEG-fMRI demonstrated two distinct clusters of blood oxygenation level dependent (BOLD) signal increases linked to IED, one located in the left frontal pole and the other in the ipsilateral dorso-lateral frontal cortex. DCM of the IED-related BOLD signal favored a model corresponding to the left dorso-lateral frontal cortex as driver of changes in the fronto-polar region. The validity of DCM was supported by: (a) the results of two different non-invasive analysis obtained on the same dataset: EEG source imaging (ESI), and "psycho-physiological interaction" analysis; (b) the failure of a first surgical intervention limited to the fronto-polar region; (c) the results of the intracranial EEG monitoring performed after the first surgical intervention confirming a SOZ located over the dorso-lateral frontal cortex. These results add evidence that EEG-fMRI together with advanced methods of BOLD signal analysis is a promising tool that can give relevant information within the epilepsy surgery diagnostic work-up.

Keywords: EEG; dynamic causal modeling; effective connectivity; epilepsy surgery; fMRI; functional neuroimaging; intracerebral recordings; seizure onset zone

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