P08-S Combined electromagnetic source imaging in presurgical evaluation

Abstract

Background To date, source imaging (SI) has been performed using epileptiform discharges (ED) detected by magnetoencephalography (MEG) or electroencephalography (EEG). A few case studies has combined MEG and EEG recordings and performed electromagnetic source imaging (cEMSI). This study tries to elucidate the role of cEMSI in presurgical evaluation. Material and methods A MEG whole-head 306-channel Elekta Neuromag® system, and simultaneous high density EEG (70 electrodes, range 58–80) using a non-magnetic cap (EASYCAP) were recorded in 141 consecutive patients. Fifty patients were operated and had one year follow up. MEG-EEG was inspected for EDs. Signals were analyzed using CURRY 7 Neuroimaging Suite. For each cluster, using the visually detected EDs as templates, automated algorithms scanned the recordings, and detected EDs were visually checked. To improve the signal-to-noise ratio, EDs with similar topography were averaged. Two different inverse solutions were applied: equivalent current dipole (ECD) and a distributed source model (DSM): sLORETA. We performed electric SI, magnetic SI, and cEMSI. All analyses were performed using individual head models from the patients’ MRIs. We calculated the odds ratio (OR) of becoming seizure-free when operation was concordant vs discordant with the localization of the SI. Results Combining both EEG and MEG signals (cEMSI) gave an OR of 5.8 for ECD and 19.2 for DSM. OR of cEMSI using DSM was significantly higher than both ESI (p = 0.02) and MSI (p = 0.03). Conclusion Combined EMSI achieved significantly higher odds ratio for becoming seizure-free compared to electric SI and magnetic SI.