Precise localization of epileptic foci is an unavoidable prerequisite in epilepsy surgery. Simultaneous EEG-fMRI recording has recently created new horizons to locate foci in patients with epilepsy and, in comparison with single-modality methods, has yielded more promising results although it is still subject to limitations such as lack of access to information between interictal events. This study assesses its potential added value in the presurgical evaluation of patients with complex source localization. Adult candidates considered ineligible for surgery on account of an unclear focus and/or presumed multifocality on the basis of EEG underwent EEG-fMRI. Adopting a component-based approach, this study attempts to identify the neural behavior of the epileptic generators and detect the components-of-interest which will later be used as input in the GLM model, substituting the classical linear regressor. Twenty-eight sets interictal epileptiform discharges (IED) from nine patients were analyzed. In eight patients, at least one BOLD response was significant, positive and topographically related to the IEDs. These patients were rejected for surgery because of an unclear focus in four, presumed multifocality in three, and a combination of the two conditions in two. Component-based EEG-fMRI improved localization in five out of six patients with unclear foci. In patients with presumed multifocality, component-based EEG-fMRI advocated one of the foci in five patients and confirmed multifocality in one of the patients. In seven patients, component-based EEG-fMRI opened new prospects for surgery and in two of these patients, intracranial EEG supported the EEG-fMRI results. In these complex cases, component-based EEG-fMRI either improved source localization or corroborated a negative decision regarding surgical candidacy. As supported by the statistical findings, the developed EEG-fMRI method leads to a more realistic estimation of localization compared to the conventional EEG-fMRI approach, making it a tool of high value in pre-surgical evaluation of patients with refractory epilepsy. To ensure proper implementation, we have included guidelines for the application of component-based EEG-fMRI in clinical practice.

癫痫病灶的精确定位是癫痫手术不可避免的先决条件。同步 EEG-fMRI 记录最近为癫痫患者的病灶定位开辟了新视野，并且与单一模式方法相比，取得了更有希望的结果，尽管它仍然受到诸如在发作间期事件之间缺乏信息获取等限制。本研究评估了其在复杂源定位患者术前评估中的潜在附加价值。由于 EEG 的焦点不明确和/或假定为多焦点而被认为不适合手术的成年候选人接受了 EEG-fMRI。采用基于组件的方法，本研究试图识别癫痫发生器的神经行为并检测感兴趣的成分，这些成分稍后将用作 GLM 模型的输入，替代经典的线性回归器。分析了来自 9 名患者的 28 组发作间期癫痫样放电 (IED)。在 8 名患者中，至少有一项 BOLD 反应是显着的、阳性的并且与 IED 的地形相关。这些患者被拒绝接受手术，因为其中 4 人的病灶不明确，3 人被假定为多灶性，2 人同时存在这两种情况。基于组件的 EEG-fMRI 改善了六分之五的病灶不明确患者的定位。在推测为多灶性的患者中，基于成分的 EEG-fMRI 提倡 5 名患者的病灶之一，并在其中一名患者中证实了多灶性。在七名患者中，基于组件的 EEG-fMRI 为手术开辟了新的前景，其中两名患者的颅内 EEG 支持 EEG-fMRI 结果。在这些复杂的情况下，基于组件的 EEG-fMRI 要么改善了源定位，要么证实了关于手术候选资格的负面决定。正如统计结果所支持的那样，与传统的 EEG-fMRI 方法相比，开发的 EEG-fMRI 方法可以更真实地估计定位，使其成为难治性癫痫患者术前评估的高价值工具。为了确保正确实施，我们已经包含了基于组件的 EEG-fMRI 在临床实践中的应用指南。基于组件的 EEG-fMRI 要么改善了源定位，要么证实了关于手术候选资格的负面决定。正如统计结果所支持的那样，与传统的 EEG-fMRI 方法相比，开发的 EEG-fMRI 方法可以更真实地估计定位，使其成为难治性癫痫患者术前评估的高价值工具。为了确保正确实施，我们已经包含了基于组件的 EEG-fMRI 在临床实践中的应用指南。基于组件的 EEG-fMRI 要么改善了源定位，要么证实了关于手术候选资格的负面决定。正如统计结果所支持的那样，与传统的 EEG-fMRI 方法相比，开发的 EEG-fMRI 方法可以更真实地估计定位，使其成为难治性癫痫患者术前评估的高价值工具。为了确保正确实施，我们已经包含了基于组件的 EEG-fMRI 在临床实践中的应用指南。使其成为难治性癫痫患者术前评估的高价值工具。为了确保正确实施，我们已经包含了基于组件的 EEG-fMRI 在临床实践中的应用指南。使其成为难治性癫痫患者术前评估的高价值工具。为了确保正确实施，我们已经包含了基于组件的 EEG-fMRI 在临床实践中的应用指南。