# Seizure onset zone localization with functional MRI correlates of interictal physiology in temporal lobe epilepsy

> **NIH NIH F31** · VANDERBILT UNIVERSITY · 2024 · $48,974

## Abstract

PROJECT SUMMARY/ABSTRACT
Approximately 40% of patients with epilepsy are resistant to drug treatment. These patients may benefit from
targeted surgical interventions, such as surgical resection or neurostimulation of the seizure onset zone (SOZ).
Patients being considered for surgical intervention undergo a series of noninvasive diagnostic tests to localize
their SOZ. If these noninvasive tests cannot delineate the SOZ clearly enough for surgical intervention, patients
undergo intracranial electroencephalography (iEEG) to more accurately localize their SOZ. Yet, even in patients
who undergo iEEG, SOZ localization and subsequent surgical treatment only leads to seizure freedom in 47-
68% of patients, which can be partially attributed to SOZ mis-localization. Thus, there is a need for more accurate
noninvasive SOZ localization methods to guide iEEG implantation and surgical treatment for improvement of
seizure outcomes after surgical intervention. Resting-state, interictal (between seizure) functional magnetic
resonance imaging (fMRI) noninvasively measures fluctuations in blood oxygenation, an indirect measure of
brain activity. In this proposal, we aim to develop two novel interictal fMRI SOZ localization methods that improve
upon current noninvasive methods by leveraging interictal physiological abnormalities of the SOZ. We will
develop these methods in patients with temporal lobe epilepsy as a well-characterized model of focal epilepsy.
Interictal epileptic spikes, large amplitude electrical events, are detected clinically with noninvasive scalp EEG
to localize the SOZ. However, clinical interictal spike localization methods are limited by low sensitivity to detect
spikes and either poor spatial resolution or specialized hardware and extensive preprocessing. There is evidence
that interictal epileptic spikes induce specific dynamic fMRI connectivity patterns, therefore, here we propose to
develop a method to detect and localize interictal epileptic spikes with dynamic fMRI connectivity (Aim 1). We
hypothesize that interictal epileptic spikes identified on scalp EEG induce dynamic fMRI connectivity patterns
that could be used to detect and localize spikes with fMRI alone. Fluorodeoxyglucose (FDG) positron emission
tomography (PET) is used clinically to image the glucose hypometabolism of epileptic regions, however, this
method has limited utility for SOZ localization due to the moderate specificity of hypometabolism to the SOZ. We
aim to improve the specificity of FDG-PET SOZ localization by combining it with fMRI (Aim 2). We hypothesize
that the SOZ has atypical physiological uncoupling of interictal metabolic (FDG-PET) and hemodynamic (fMRI)
activity that could be used for localization. If successful, these studies will provide more accurate and specific
noninvasive SOZ localization methods that could be integrated into presurgical noninvasive testing to guide both
iEEG implantation and surgical intervention, ultimately improving seizure outco...

## Key facts

- **NIH application ID:** 10898426
- **Project number:** 1F31NS135908-01A1
- **Recipient organization:** VANDERBILT UNIVERSITY
- **Principal Investigator:** Lucas Sainburg
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $48,974
- **Award type:** 1
- **Project period:** 2024-05-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10898426

## Citation

> US National Institutes of Health, RePORTER application 10898426, Seizure onset zone localization with functional MRI correlates of interictal physiology in temporal lobe epilepsy (1F31NS135908-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10898426. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*