# Spatial and spectral structure of local functional connectivity of the background intracranial EEG in patients with focal epilepsy

## TL;DR

This study shows that brain connectivity patterns in specific frequency bands near the seizure onset area are linked to better outcomes after epilepsy surgery.

## Contribution

The study identifies stable, frequency-specific connectivity patterns in the background EEG as potential network markers for epilepsy surgery outcomes.

## Key findings

- BRLFC in the SOA and peri-SOA was higher in patients with excellent surgical outcomes.
- Connectivity decreased with distance from the SOA, especially in alpha, beta, gamma, and high frequency bands.
- The relationship between BRLFC and distance to SOA was consistent regardless of anti-seizure medication use.

## Abstract

To determine the frequency band-related local functional connectivity (BRLFC) of the seizure onset area (SOA) and areas removed from it, and the relationship between BRLFC and outcome of epilepsy surgery.

This study was conducted on 14 unselected adult patients with focal epilepsy undergoing icEEG monitoring for surgery. Intracranial EEG (icEEG) electrode contacts were located from post-implantation CT and MR images and registered to the MRI of a common brain to allow interpretation of results from all patients in the same space. Two 1 h icEEG epochs, recorded during wake and removed in time from seizure occurrence, were studied. One of these epochs was when the subject was on anti-seizure medications (ASMs), while the second was after ASM taper. Coherence was estimated for all pairs of electrode contacts ipsilateral to the SOA in delta, theta, alpha, beta, gamma and a high frequency band. The BRLFC of each electrode contact was estimated as the average band-related coherence between it and all electrode contacts within a spatial window.

BRLFC in the SOA and peri-SOA, for selected frequency bands, was greater in patients with excellent outcome after surgery in comparison to those with poor outcome. A graded relationship was observed between BRLFC and distance to the SOA of patients with excellent outcome to surgery such that contacts with the greatest connectivity were closer to the SOA and those with the lowest connectivity were several cm from the SOA. This relationship between distance to the SOA and connectivity was present primarily in the alpha, beta, gamma and high frequency bands and the BRLFC was greatest in the peri-SOA, within a distance of 5 cm from the SOA. This relationship was stable between on-ASMs and off-ASMs epochs.

There is stable altered BRLFC in the SOA and peri-SOA expressed in the background icEEG of patients with focal epilepsy. This altered BRLFC may be a network marker of medically intractable focal epilepsy which is related to outcome of epilepsy surgery.