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Objectives:Accurate delineation of the seizure-onset zone (SOZ) in focal drug-resistant epilepsy often requires stereo-electroencephalography (SEEG) recordings. We aimed at: (1) proposing a truly objective and quantitative comparison between electro-encephalography/magnetoencephalography (EEG/MEG) source-imaging (EMSI), EEG/functional MRI (EEG/fMRI) responses for similar spikes with primary-irritative zone (PIZ) and SOZ defined by SEEG and (2) evaluating the value of EMSI and EEG/fMRI to predict postsurgical outcome.Methods:We identified patients with drug-resistant epilepsy who underwent EEG/MEG, EEG/fMRI, and subsequent SEEG at the Epilepsy Service from the Montreal Neurological Institute and Hospital. We quantified multimodal concordance within the SEEG channel-space, as spatial overlap with PIZ/SOZ and distances to the Spike-onset, Spike-maximum-amplitude and Seizure-core intracerebral channels, by applying a new methodology consisting of converting EMSI results into SEEG electrical potentials (EMSIe−SEEG) and projecting the most significant fMRI response on the SEEG channels (fMRIp−SEEG). Spatial overlaps with PIZ/SOZ (AUCPIZ, AUCSOZ) were assessed by using the area under the receiver operating characteristic curve (AUC). Here, AUC represents the probability that a randomly picked active contact exhibited higher amplitude when located inside the spatial reference than outside.Results:Seventeen patients were included. Mean spatial overlaps with the primary-irritative zone and seizure-onset zone were 0.71 and 0.65 for EMSIe−SEEG, and 0.57 and 0.62 for fMRIp−SEEG. Good EMSIe−SEEG  spatial overlap with the primary-irritative zone was associated with smaller distance from the maximum EMSIe−SEEG contact to the Spike-maximum-amplitude channel (median distance 14 mm). Conversely, good fMRIp−SEEG spatial overlap with the seizure-onset zone was associated with smaller distances from the maximum  fMRIp−SEEG contact to the Spike-onset and Seizure-core channels (median distances 10 mm and 5mm respectively). Surgical outcomes were correctly predicted by EEG/MEG in 12/15 (80%) patients and EEG/fMRI in 6/11(54%) patients.Conclusions:Using a unique quantitative approach estimating EMSI and fMRI results in the reference SEEG channel-space, EEG/MEG and EEG/fMRI accurately localized the seizure-onset zone as well as the primary-irritative zone. Precisely, EEG/MEG more accurately localized the primary-irritative zone, whereas EEG/fMRI was more sensitive to the seizure-onset zone. Both neuro-imaging techniques provide complementary localization that can help guiding SEEG implantation and selecting good candidates for surgery.

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Background: Magnetoencephalography (MEG) is a widely used non-invasive tool to estimate brain activity with high temporal resolution. However, due to the ill-posed nature of the MEG source imaging (MSI) problem, the ability of MSI to identify accurately underlying brain sources along the cortical surface is still uncertain and requires validation. Method: We validated the ability of MSI to estimate the background resting state activity of 45 healthy participants by comparing it to the intracranial EEG (IEEG) atlas (https://mni-open-ieegatlas.research.mcgill.ca/). First, we applied wavelet-based Maximum Entropy on the Mean (wMEM) as an MSI technique. Next, we converted MEG source maps into intracranial space, by applying a forward model to the MEG reconstructed source maps and estimated virtual IEEG (VIEEG) potentials on each IEEG channel location and quantitatively compared those with actual IEEG signals from the atlas for 38 regions of interest in the canonical frequency bands. Results: The MEG spectra were more accurately estimated in the lateral regions compared to the medial regions. The regions with higher amplitude in the VIEEG than in the IEEG were more accurately recovered. In the deep regions, MEG estimated amplitudes were largely underestimated and the spectra were poorly recovered. Moreover, the MEG largely overestimated oscillatory peaks in the alpha band, especially in the anterior and deep regions. This is possibly due to higher phase synchronization of alpha oscillations over extended regions, exceeding the spatial sensitivity of IEEG but detected by MEG. Importantly, we found that MEG estimated spectra were more comparable to spectra from the IEEG atlas after the aperiodic components were removed. Conclusion: This study identifies brain regions and frequencies for which MEG source analysis is likely to be reliable, a promising step towards resolving the uncertainty in recovering intracerebral activity from non-invasive MEG studies.