Clinical benefit of presurgical EEG‐fMRI in difficult‐to‐localize focal epilepsy: A single‐institution retrospective review

Objective The aim of this report is to present our clinical experience of electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) in localizing the epileptogenic focus, and to evaluate the clinical impact and challenges associated with the use of EEG‐fMRI in pharmacoresistant focal epilepsy. Methods We identified EEG‐fMRI studies (n = 118) in people with focal epilepsy performed at our center from 2003 to 2018. Participants were referred from our Comprehensive Epilepsy Program in an exploratory research effort to address often difficult clinical questions, due to complex and difficult‐to‐localize epilepsy. We assessed the success of each study, the clinical utility of the result, and when surgery was performed, the postoperative outcome. Results Overall, 50% of EEG‐fMRI studies were successful, meaning that data were of good quality and interictal epileptiform discharges were recorded. With an altered recruitment strategy since 2012 with increased inclusion of patients who were inpatients for video‐EEG monitoring, we found that this patients in this selected group were more likely to have epileptic discharges detected during EEG‐fMRI (96% of inpatients vs 29% of outpatients, P