Localising epileptiform activity and eloquent cortex using magnetoencephalography

Abstract

In patients with drug resistant epilepsy, the surgical resection of epileptogenic cortex allows the possibility for seizure freedom, provided that epileptogenic and eloquent brain tissue can be accurately identified prior to surgery. This is often achieved using various techniques including neuroimaging, electroencephalographic (EEG), neuropsychological and invasive measurements. Over the last 20 years, magnetoencephalography (MEG) has emerged as a non-invasive tool that can provide important clinical information to patients with suspected neocortical epilepsy being considered for surgery. The standard clinical MEG analyses to localise abnormalities are not always successful and therefore the development and evaluation of alternative methods are warranted. There is also a continuous need to develop MEG techniques to delineate eloquent cortex. Based on this rationale, this thesis is concerned with the presurgical evaluation of drug resistant epilepsy patients using MEG and consists of two themes: the first theme focuses on the refinement of techniques to functionally map the brain and the second focuses on evaluating alternative techniques to localise epileptiform activity. The first theme involved the development of an alternative beamformer pipeline to analyse Elekta Neuromag data and was subsequently applied to data acquired using a pre-existing and a novel language task. The findings of the second theme demonstrated how beamformer based measures can objectively localise epileptiform abnormalities. A novel measure, rank vector entropy, was introduced to facilitate the detection of multiple types of abnormal signals (e.g. spikes, slow waves, low amplitude transients). This thesis demonstrates the clinical capacity of MEG and its role in the presurgical evaluation of drug resistant epilepsy patients.