Quadrimodal localisation of epileptic focus using simultaneous EEG, (f)MRI and PET imaging

Purpose: In patients suffering from pharmaco-resistant focal epilepsy, resection of the epileptic focus can lead to seizure-freedom or significant improvement. The localisation of the epileptic focus relies on structural and functional brain imaging and multimodal concordance is associated with a better post-operative outcome. The existence of epileptogenic lesions detectable on structural MRI and the presence of focal hypometabolism on FDG-PET, especially after coregistration with MRI are widely accepted localising findings. In addition, other tools for localising epileptic activity, such as EEG-based electric source imaging (ESI) and simultaneous EEG and functional MRI (EEG-fMRI) are increasingly used. We here report the feasibility to record in a single session combined EEG-PET, MRI, EEG-fMRI and ESI using high-density EEG and a PET-MRI hybrid scanner.