Multimodal Imaging in Pre-surgical Evaluation of Epilepsy
Multimodal Imaging in Pre-surgical Evaluation of Epilepsy
Epilepsy is the most common chronic neurological disorder in the world, affecting more than
 50 million people worldwide. Approximately 35% of patients with epilepsy are refractory to
 all available antiepileptic drugs. Drug-resistant epilepsies are often partial or focal.
 Patients with drug-resistant focal epilepsy suffer from an increased risk of death, primarily
 due to seizure-related fatalities, in comparison with the general population. The only
 therapeutic option for this form of epilepsy is the surgical removal of the region of the
 brain responsible for seizures, called the epileptogenic zone (EZ). This requires the precise
 localization of the EZ based on a comprehensive pre-surgical evaluation of patients.

 Today the gold standard for localizing the EZ and validating a non-invasive technique for
 localization of the EZ remains intracerebral stereo-EEG (stereo-electroencephalography or
 SEEG) recordings of spontaneous seizures. The implementation strategy of the intracerebral
 depth electrodes is guided by clinical and neuroimaging data, including anatomical Magnetic
 Resonance Imaging (MRI), Positron Emission Tomography (PET) with FDG (fluoro-Deoxy-Glucose)
 and MagnetoEncephaloGraphy (MEG). Although the contribution of each technique in the
 pre-surgical localization of the EZ has already been shown, no wide-scale study has examined
 the cumulative contribution of these three techniques.
The purpose of this study is (i) to evaluate rigorously the diagnostic value of multimodal
 imaging for non-invasive localization of the EZ and (ii) to better target the indications for
 intracerebral recordings (SEEG).
Inclusion Criteria:

 -  Patient with drug-resistant focal epilepsy

 -  Candidates for pre-surgical evaluation including FDG PET, MRI, MEG and SEEG
 recordings.

 -  Age 18-65 years

 -  EEG-confirmed focal epilepsy for >2 years

 -  Signed informed consent form.

 Exclusion Criteria:

 -  Age <18 years and >65 years

 -  Contraindication to the MRI

 -  Pregnant woman

 -  Head size incompatible with MEG recordings

 -  Adult subject to legal protection measure.