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electroencephalopraphy (EEG) was performed. A novel obtained included age, sex, seizure characteristics, MRI
machine learning-based IED-detection algorithm was brain, EEG, MEG, intracranial EEG, type of intervention,
developed to aid identification of on-scalp MEG unique and seizure outcomes.
IEDs.
RESULTS Twenty-four patients (12 adults and 12 pe-
RESULTS Conventional MEG contained 24 IEDs. On- diatric) were included. Eight patients had one staged
scalp MEG revealed 47 IEDs (16 co-registered by EEG, 31 intervention and 16 had intracranial evaluation. Ten of
unique to the on-scalp MEG recording). 11 patients (91%) with insular coverage by stereotactic
EEG had interictal insular spikes, and 5 of 11 patients
CONCLUSION Our results indicate that on-scalp MEG (45%) had ictal onset from the insula. Combined Engel
might capture IEDs not seen by other non-invasive (I & II) outcomes were seen in five patients with resec-
modalities. tions/ablations involving the insula MEG dipole clusters
as compared with eight patients where the insular MEG
SIGNIFICANCE On-scalp MEG has the potential of dipole clusters were not resected/ablated.
improving non-invasive epilepsy evaluation.
CONCLUSIONS Insular MEG dipole clusters identified
Keywords: Epilepsy, High-critical temperature SQUIDs, on surface MEG correlated with interictal spikes in intra-
Instrumentation, Interictal epileptiform discharges, Mag- cranial stereotactic electrode contacts in the insula. The
netoencephalography presence of insular MEG dipole clusters, however, does
not definitively imply a primary insular onset epilepsy.
Clinical neurophysiology: official journal of the
International Federation of Clinical Neurophysiology Journal of clinical neurophysiology: official publication
(2020), Vol. 131, No. 8 (32504930) (3 citations) of the American Electroencephalographic Society (2021),
Vol. 38, No. 6 (32501951) (4 citations)

Insular Magnetoencephalography Dipole Clusters
in Patients With Refractory Focal Epilepsy (2021) Evidence From Meta-Analysis Supports Ictal
Magnetoencephalographic Source Imaging as
Chourasia, Nitish; Quach, Michael; Gavvala, Jay an Accurate Method in Presurgery Evaluation of
Patients With Drug-Resistant Epilepsy (2020)
Division of Epilepsy and Clinical Neurophysiology, Depart-
ment of Pediatric Neurology, Baylor College of Medicine, Brændholt, Malthe; Jensen, Mads
Houston, Texas, U.S.A.; and; Division of Epilepsy and Clinical
Neurophysiology, Department of Adult Neurology, Baylor Embodied Computation Group, Center of Functionally Inte-
College of Medicine, Houston, Texas, U.S.A grative Neuroscience, Aarhus University, Aarhus, Denmark;
NedComm Lab-Laboratory of NeuroDynamics of Human
PURPOSE The clinical significance of magnetoenceph- Communication and Center of Functionally Integrative Neu-
alography (MEG) dipole clusters in the insular region in roscience, Aarhus University, Aarhus, Denmark
patients with focal epilepsy, when present in conjunc-
tion with MEG dipole clusters in other regions of the BACKGROUND. Successful epilepsy surgery relies on
brain is not known. localization and removal of the brain area responsible
for initializing the seizures called the epileptogenic
METHODS All patients (adult and pediatric) with MEG zone (EZ). Intracranial EEG (icEEG) is gold standard of
dipole clusters involving the insula were retrospec- this localization but has several limitations like invasive-
tively evaluated. Patients who underwent any form of ness and limited covered area. A noninvasive method
surgical intervention were included in the study. Data with accurate localization precision is therefore desir-

 ontents  Index 181
C