No abstract

Malformations of cortical development (MCDs) are commonly complicated by intractable focal epilepsy. Epileptogenesis in these disorders is not well understood and may depend on the type of MCD. The cellular mechanisms involved in interictal and ictal events are notably different, and could be influenced independently by the type of pathology. We evaluated the relationship between interictal and ictal zones in eight patients with different types of MCD in order to better understand the generation of these activities: four had nodular heterotopia, two focal cortical dysplasia and two subcortical band heterotopia (double-cortex). We used the non-invasive EEG-fMRI technique to record simultaneously all cerebral structures with a high spatio-temporal resolution. We recorded interictal and ictal events during the same session. Ictal events were either electrical only or clinical with minimal motion. BOLD changes were found in the focal cortical dysplasia during interictal and ictal epileptiform events in the two patients with this disorder. Heterotopic and normal cortices were involved in BOLD changes during interictal and ictal events in the two patients with double cortex, but the maximum BOLD response was in the heterotopic band in both patients. Only two of the four patients with nodular heterotopia showed involvement of a nodule during interictal activity. During seizures, although BOLD changes affected the lesion in two patients, the maximum was always in the overlying cortex and never in the heterotopia. For two patients intracranial recordings were available and confirm our findings. The dysplastic cortex and the heterotopic cortex of band heterotopia were involved in interictal and seizure processes. Even if the nodular gray matter heterotopia may have the cellular substrate to produce interictal events, the often abnormal overlying cortex is more likely to be involved during the seizures. The non-invasive BOLD study of interictal and ictal events in MCD patients may help to understand the role of the lesion in epileptogenesis and also determine the potential surgical target.

Objective-We evaluated BOLD correlates of alertness fluctuations commonly seen during prolonged EEG-fMRI studies to better define the brain areas active at different phases of vigilance and to assess the contribution of these fluctuations to the BOLD signal.Methods-We evaluated BOLD changes specifically related to the main physiological EEG rhythms (alpha, beta, theta, delta, spindles) in 15 epilepsy patients with rare discharges (all the regressors were included in the same general linear model to improve specificity).Results-We found a consistent effect of spindles, alpha and theta. For alpha, BOLD was positively correlated in thalami and putamen, and negatively correlated in the occipital, parietal and frontal lobes. For theta, a negative correlation was found over the parietal, temporal and frontal lobes. Spindles were correlated with a positive BOLD in thalami and putamen. Rhythm regressors added as confounds in the fMRI analysis explained at least 5% of BOLD signal variance in 6.8 ± 8.9% of gray matter voxels, a contribution which is of the order of typical changes in fMRI studies.Conclusion-First, we found specific cerebral structures involved in each main EEG rhythm generation. Second, fluctuations of these rhythms following vigilance changes are responsible for noteworthy BOLD changes. Significance: Physiological EEG rhythms may be integrated to the analysis of EEG-fMRI in studies with fluctuation of alertness, to eliminate possible confounding factors.

Our study provides different types of support (topography, concordance with PET and SPECT, structural peculiarities, postoperative histology) that EEG-fMRI may help to delineate the epileptic focus in patients with nonlesional frontal lobe epilepsy, a challenging group in the preoperative evaluation.