fMRI Activation in Continuous and Spike-triggered EEG-fMRI Studies of Epileptic Spikes

Abdulla Al-Asmi, Christian G. Bénar, Don W. Gross, Yayha Agha Khani, Frederick Andermann, Bruce Pike, François Dubeau, Jean Gotman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

187 Citations (Scopus)


Purpose: To evaluate functional magnetic resonance imaging (fMRI) with simultaneous EEG for finding metabolic sources of epileptic spikes. To find the localizing value of activated regions and factors influencing fMRI responses. Methods: Patients with focal epilepsy and frequent spikes were subjected to spike-triggered or continuous fMRI with simultaneous EEG. Results were analyzed in terms of fMRI activation, concordance with the location of EEG spiking and anatomic MRI abnormalities, and other EEG and clinical variables. In four patients, results also were compared with those of intracerebral EEG. Results: Forty-eight studies were performed on 38 patients. Seventeen studies were not analyzed, primarily because no spikes occurred during scanning. Activation was obtained in 39% of 31 studies, with an activation volume of 2.55 ± 4.84 cc. Activated regions were concordant with EEG localization in almost all studies and confirmed by intracerebral EEG in four patients. Forty percent of patients without an MRI lesion showed activation; 37.5% of patients with a lesion had an activation; the activation was near or inside the lesion. Bursts of spikes were more likely to generate an fMRI response than were isolated spikes (76 vs. 11%; p < 0.05). Conclusions: Combining EEG and fMRI in focal epilepsy yields regions of activation that are presumably the source of spiking activity. These regions are highly linked with epileptic foci and epileptogenic lesions in a significant number of patients. Activation also is found in patients with no visible MRI lesion. Intracerebral recordings largely confirm that these activation regions represent epileptogenic areas. It is still unclear why many patients show no activation.

Original languageEnglish
Pages (from-to)1328-1339
Number of pages12
Issue number10
Publication statusPublished - Oct 2003
Externally publishedYes


  • Activation
  • Functional magnetic resonance imaging
  • Spikes

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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