High-Density EEG Source Imaging for Surgical Management of Drug-Resistant Focal Epilepsy: A Retrospective Study

Objective: In this retrospective study, we examined the efficacy of high-density EEG (HD-EEG) source imaging in the surgical management of drug-resistant focal epilepsy.

Methods: We included thirteen patients who underwent excisional surgery for drug-resistant focal epilepsy between June 2019 to July 2022 and met the following criteria: (1) seizure freedom at 1-year follow-up; (2) preoperative T1-weighted brain MRI and postoperative brain MRI; and (3) underwent HD EEG of 256-electrode array recording. We analyzed patient demographics, HDEEG recording, interictal discharges and ECD dipole modeling performed using the BESA Research 7.1 software package. Experienced epileptologists determined whether electrical source imaging (ESI) analysis is using ECD dipole models localized within the surgical resection cavity (SRC).

Results: Thirteen patients were included in the study, who underwent HD-EEG recording and had pre and postoperative brain MRI. The mean age at surgery was 22.46 (range: 7–48 years). Of these, 6 (46.15%) patients had ETLE, 5 (38.46) had TLE, and 2 (15.38) had T-plus epilepsy. Ten patients (76.92%) had positive preoperative brain MRI and 2 (15.38%) patients had negative preoperative brain MRI. ECD dipole analysis highly correlated with the surgical resective cavity in 10 (76.92%) patients, indicating the effectiveness of HD-EEG in localization of epileptic focus for surgical management.

Conclusion: Our study demonstrates that HD-EEG electrical source imaging is an effective tool for presurgical planning, particularly in patients with drug-resistant focal epilepsy. The use of HD-EEG can significantly improve surgical outcomes and reduce the burden of epilepsy for these patients.

Publication History

Article published online:
12 September 2024