Towards fast and reliable simultaneous EEG-fMRI analysis of epilepsy with automatic spike detection

ObjectiveThe process of manually marking up epileptic spikes for simultaneous electroencephalogram (EEG) and resting state functional MRI (rsfMRI) analysis in epilepsy studies is a tedious and subjective task for a human expert. The aim of this study was to evaluate whether automatic EEG spike detection can facilitate EEG-rsfMRI analysis, and to assess its potential as a clinical tool in epilepsy.\n\nMethodsWe implemented a fast algorithm for detection of uniform interictal epileptiform discharges (IEDs) in one-hour scalp EEG recordings of 19 refractory focal epilepsy datasets (from 16 patients) who underwent a simultaneous EEG-rsfMRI recording. Our method was based on matched filtering of an IED template (derived from human markup) used to automatically detect other similar EEG events. We comprehensively compared simultaneous EEG-rsfMRI results between automatic IED detection and standard analysis with human EEG markup only.\n\nResultsIn contrast to human markup, automatic IED detection takes a much shorter time to detect IEDs and export an output text file containing spike timings. In 13/19 focal epilepsy cases, statistical EEG-rsfMRI maps based on automatic spike detection method were comparable with human markup, and in 6/19 focal epilepsy cases it revealed additional brain regions not seen with human EEG markup. Additional events detected by our automated method independently revealed similar patterns of activation to a human markup. Overall, automatic IED detection provides greater statistical power in EEG-rsfMRI analysis compared to human markup in a short timeframe.\n\nConclusionsAutomatic spike detection is a simple and fast method that can reproduce comparable and, in some cases, even superior results compared to the common practice of manual EEG markup in EEG-rsfMRI analysis of epilepsy.\n\nSignificanceOur study shows that IED detection algorithms can be effectively used in epilepsy clinical settings. This work further helps in translating EEG-rsfMRI research into a fast, reliable and easy-to-use clinical tool for epileptologists. Our IED detection approach will be publicly available as a MATLAB package at: https://github.com/omidvarnia/Automatic_focal_spike_detection.\n\nHighlightsO_LIAutomatic spike detection increases the number of detected uniform epileptic interictal discharges and enhances statistical power of EEG-rsfMRI inter-subject variability maps,\nC_LIO_LIAutomatic spike detection can identify additional activated brain regions with presumed epileptogenic focus not seen in standard analysis based on human markup,\nC_LIO_LIAutomatic spike detection can shorten the IED identification process.\nC_LI