Epileptic source localization with high density EEG: how many electrodes are needed?

OBJECTIVE: Electroencephalography (EEG) source reconstruction is becoming recognized as a useful technique to non-invasively localize the epileptic focus. Whereas, large array magnetoencephalography (MEG) systems are available since quite some time, application difficulties have previously prevented multichannel EEG recordings. Recently, however, EEG systems which allow for quick (10-20min) application of, and recording from, up to 125 electrodes have become available. The purpose of the current investigation was to systematically compare the accuracy of epileptic source localization with high electrode density to that obtained with sparser electrode setups.
METHODS: Interictal epileptiform activity was recorded with 123 electrodes in 14 epileptic patients undergoing presurgical evaluation. Each single epileptiform potential was down sampled to 63 and 31 electrodes, and a distributed source model (EPIFOCUS) was used to reconstruct the sources with the 3 different electrode configurations. The localization accuracy with the 3 electrode setups was then assessed, by determining the distance from the inverse solution, maximum of each single spike to the epileptogenic lesion.
RESULTS: In 9/14 patients, the distance from the EEG source to the lesion was significantly smaller with 63 than with 31 electrodes, and increasing the number of electrodes to 123 increased this number of patients from 9 to 11. Simulations confirmed the relation between the number of electrodes and localization accuracy.
CONCLUSIONS: The results illustrate the necessity of multichannel EEG recordings for high source location accuracy in epileptic patients.