TY - JOUR
T1 - The Concept of Effective Inflow
T2 - Application to Interictal Localization of the Epileptogenic Focus from iEEG
AU - Vlachos, Ioannis
AU - Krishnan, Balu
AU - Treiman, David M.
AU - Tsakalis, Konstantinos
AU - Kugiumtzis, Dimitris
AU - Iasemidis, Leon D.
N1 - Publisher Copyright:
© 1964-2012 IEEE.
PY - 2017/9
Y1 - 2017/9
N2 - Goal: Accurate determination of the epileptogenic focus is of paramount diagnostic and therapeutic importance in epilepsy. The current gold standard for focus localization is from ictal (seizure) onset and thus requires the occurrence and recording of multiple typical seizures of a patient. Localization of the focus from seizure-free (interictal) periods remains a challenging problem, especially in the absence of interictal epileptiform activity. Methods: By exploring the concept of effective inflow, we developed a focus localization algorithm (FLA) based on directed connectivity between brain sites. Subsequently, using the measure of generalized partial directed coherence over a broad frequency band in FLA for the analysis of interictal periods from long-term (days) intracranial electroencephalographic signals, we identified the brain region that is the most frequent receiver of maximal effective inflow from other brain regions. Results: In six out of nine patients with temporal lobe epilepsy, the thus identified brain region was a statistically significant outlier (p < 0.01) and coincided with the clinically assessed epileptogenic focus. In the remaining three patients, the clinically assessed focus still exhibited the highest inflow, but it was not deemed an outlier (p > 0.01). Conclusions: These findings suggest that the epileptogenic focus is a region of intense influence from other regions interictally, possibly as a mechanism to keep it under control in seizure-free periods. Significance: The developed framework is expected to assist with the accurate epileptogenic focus localization, reduce hospital stay and healthcare cost, and provide guidance to treatment of epilepsy via resective surgery or neuromodulation.
AB - Goal: Accurate determination of the epileptogenic focus is of paramount diagnostic and therapeutic importance in epilepsy. The current gold standard for focus localization is from ictal (seizure) onset and thus requires the occurrence and recording of multiple typical seizures of a patient. Localization of the focus from seizure-free (interictal) periods remains a challenging problem, especially in the absence of interictal epileptiform activity. Methods: By exploring the concept of effective inflow, we developed a focus localization algorithm (FLA) based on directed connectivity between brain sites. Subsequently, using the measure of generalized partial directed coherence over a broad frequency band in FLA for the analysis of interictal periods from long-term (days) intracranial electroencephalographic signals, we identified the brain region that is the most frequent receiver of maximal effective inflow from other brain regions. Results: In six out of nine patients with temporal lobe epilepsy, the thus identified brain region was a statistically significant outlier (p < 0.01) and coincided with the clinically assessed epileptogenic focus. In the remaining three patients, the clinically assessed focus still exhibited the highest inflow, but it was not deemed an outlier (p > 0.01). Conclusions: These findings suggest that the epileptogenic focus is a region of intense influence from other regions interictally, possibly as a mechanism to keep it under control in seizure-free periods. Significance: The developed framework is expected to assist with the accurate epileptogenic focus localization, reduce hospital stay and healthcare cost, and provide guidance to treatment of epilepsy via resective surgery or neuromodulation.
KW - Epilepsy
KW - epileptogenic focus localization
KW - frequency-based connectivity analysis
KW - generalized partial directed coherence (GPDC)
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U2 - 10.1109/TBME.2016.2633200
DO - 10.1109/TBME.2016.2633200
M3 - Article
C2 - 28092511
AN - SCOPUS:85029863871
SN - 0018-9294
VL - 64
SP - 2241
EP - 2252
JO - IEEE Transactions on Biomedical Engineering
JF - IEEE Transactions on Biomedical Engineering
IS - 9
M1 - 7762148
ER -