Abstracts

Rationale: The purpose of this study was to prospectively investigate the seizure onset zone (SOZ) localization of functional connectivity changes in a consecutive population of pediatric intractable epilepsy in comparison to the source identified by intra-operative electrocorticography. Methods: We developed SOZ localization criteria by performing independent component analysis on resting state functional MRI signal sources in 350 pediatric patients evaluated for epilepsy surgery over a 3 year period.  These criteria were then applied prospectively to resting state results in forty patients who went on to have intra-operative electrocorticography for seizure onset zone identification. Results: Agreement between electrocorticography and resting state identified SOZ was 90% (36/40; 95% CI 0.76-0.97).  There were no false positives from the resting state analysis. Two children with negative electrocorticography had removal of the site identified by resting state and were seizure-free one year post-operatively. Conclusions: The resting state seizure onset zone demonstrates strong agreement with intra-operative electrocorticography, which is the gold-standard for SOZ localization. A pediatric population with intractable epilepsy was studied prospectively, providing evidence for use of resting state analysis as a diagnostic test in this population. This may be considered for clinical use in combination with multimodal ictal focus localization methods to augment pre-operative planning. Funding: No sources of funding were provided for the work presented.