{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T07:24:52Z","timestamp":1763018692033,"version":"3.40.5"},"reference-count":44,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000034","name":"Institute of Neurosciences, Mental Health and Addiction","doi-asserted-by":"publisher","award":["MOP\u2010136839"],"award-info":[{"award-number":["MOP\u2010136839"]}],"id":[{"id":"10.13039\/501100000034","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Temporal lobe epilepsy (TLE) has a high probability of becoming drug resistant and is frequently considered for surgical intervention. However, 30% of TLE cases have nonlesional magnetic resonance imaging (MRI) scans, which is associated with worse surgical outcomes. Characterizing interactions between temporal and extratemporal structures in these patients may help understand these poor outcomes. Simultaneous intracranial electroencephalography\u2013functional MRI (iEEG\u2010fMRI) can measure the hemodynamic changes associated with interictal epileptiform discharges (IEDs) recorded directly from the brain. This study was designed to characterize the whole brain patterns of IED\u2010associated fMRI activation recorded exclusively from the mesial temporal lobes of patients with nonlesional TLE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighteen patients with nonlesional TLE undergoing iEEG monitoring with mesial temporal IEDs underwent simultaneous iEEG\u2010fMRI at 3\u2009T. IEDs were marked, and statistically significant clusters of fMRI activation were identified. The locations of IED\u2010associated fMRI activation for each patient were determined, and patients were grouped based on the location and pattern of fMRI activation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two patterns of IED\u2010associated fMRI activation emerged: primarily localized (<jats:italic>n<\/jats:italic>\u2009=\u20097), where activation was primarily located within the ipsilateral temporal lobe, and primarily diffuse (<jats:italic>n<\/jats:italic>\u2009=\u200911), where widespread bilateral extratemporal activation was detected. The primarily diffuse group reported significantly fewer focal to bilateral tonic\u2013clonic seizures and had better postsurgical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Simultaneous iEEG\u2010fMRI can measure the hemodynamic changes associated with focal IEDs not visible on scalp EEG, such as those arising from the mesial temporal lobe. Significant fMRI activation associated with these IEDs was observed in all patients. Two distinct patterns of IED\u2010associated activation were seen: primarily localized to the ipsilateral temporal lobe and more widespread, bilateral activation. Patients with widespread IED associated\u2010activation had fewer focal to bilateral tonic\u2013clonic seizures and better postsurgical outcome, which may suggest a neuroprotective mechanism limiting the spread of ictal events.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18036","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T07:10:14Z","timestamp":1717744214000},"page":"2295-2307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mesial temporal lobe spiking reveals distinct patterns of <scp>blood oxygen level\u2010dependent functional magnetic resonance imaging<\/scp> activation using simultaneous intracranial electroencephalography\u2013functional magnetic resonance imaging"],"prefix":"10.1111","volume":"65","author":[{"given":"Antis G.","family":"George","sequence":"first","affiliation":[{"name":"Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary  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