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  • Review Article
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EEG source imaging in epilepsy—practicalities and pitfalls

Nature Reviews Neurology volume 8, pages 498–507 (2012)Cite this article

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Abstract

EEG source imaging (ESI) is a model-based imaging technique that integrates temporal and spatial components of EEG to identify the generating source of electrical potentials recorded on the scalp. Recent advances in computer technologies have made the analysis of ESI data less time-consuming, and have rekindled interest in this technique as a clinical diagnostic tool. On the basis of the available body of evidence, ESI seems to be a promising tool for epilepsy evaluation; however, the precise clinical value of ESI in presurgical evaluation of epilepsy and in localization of eloquent cortex remains to be investigated. In this Review, we describe two fundamental issues in ESI; namely, the forward and inverse problems, and their solutions. The clinical application of ESI in surgical planning for patients with medically refractory focal epilepsy, and its use in source reconstruction together with invasive recordings, is also discussed. As ESI can be used to map evoked responses, we discuss the clinical utility of this technique in cortical mapping—an essential process when planning resective surgery for brain regions that are in close proximity to eloquent cortex.

Key Points

  • EEG source imaging (ESI) is a model-based imaging technique that integrates temporal and spatial components of EEG to identify the source of scalp-recorded potentials

  • The choice of forward and inverse solutions can crucially influence the outcome of source localization using ESI

  • A realistic head model using an individual's MRI offers the best forward solution

  • A high total number of electrodes or concentration of electrodes over the region of interest can improve the accuracy of ESI

  • Attention to technical recording details, including co-registration of electrode positions on MRI and modelling of the initial phase of epileptic spikes, is crucial for accurate source localization using ESI

  • On the basis of current evidence, ESI is a promising tool for epilepsy evaluation, but further studies in large epilepsy cohorts are needed to demonstrate its clinical value

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Figure 1
Figure 2: The forward and inverse problems.
Figure 3: Flow diagram of the ESI process.
Figure 4: Source localization of the initial phase of epileptic spikes.
Figure 5: Validation of EEG source imaging with simultaneous scalp and intracranial EEG.

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Acknowledgements

K. Kaiboriboon and M. Hamaneh are supported by the Epilepsy Foundation. M. Hamaneh is also supported by the Coulter Foundation.

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Authors and Affiliations

  1. Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 3200, Cleveland, 44106, OH, USA

    Kitti Kaiboriboon, Hans O. Lüders, Mehdi Hamaneh, John Turnbull & Samden D. Lhatoo

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  1. Kitti Kaiboriboon
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Contributions

K. Kaiboriboon researched data for the article. K. Kaiboriboon and S. D. Lhatoo provided substantial contributions to discussion of content and wrote the article. K. Kaiboriboon, H. O. Lüders, M. Hamaneh, J. Turnbull and S. D. Lhatoo contributed equally to review and editing of the manuscript before submission.

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Correspondence to Kitti Kaiboriboon.

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Supplementary information

Supplementary Table 1

EEG source imaging software packages (DOC 57 kb)

Supplementary Table 2

Clinical studies of interictal source analysis (DOC 82 kb)

Supplementary Table 3

Clinical studies of ictal source analysis (DOC 52 kb)

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Kaiboriboon, K., Lüders, H., Hamaneh, M. et al. EEG source imaging in epilepsy—practicalities and pitfalls. Nat Rev Neurol 8, 498–507 (2012). https://doi.org/10.1038/nrneurol.2012.150

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