Patients presenting with drug-resistant epilepsy are eligible for surgery aiming to remove the regions involved in the production of seizure activities, the so-called epileptogenic zone network (EZN). Thus the accurate estimation of the EZN is crucial. Data-driven, personalized virtual brain models derived from patient-specific anatomical and functional data are used in Virtual Epileptic Patient (VEP) to estimate the EZN via optimization methods from Bayesian inference. The Bayesian inference approach used in previous VEP integrates priors, based on the features of stereotactic-electroencephalography (SEEG) seizures’ recordings. Here, we propose new priors, based on quantitative 23 Na-MRI. The 23 Na-MRI data were acquired at 7T and provided several features characterizing the sodium signal decay. The hypothesis is that the sodium features are biomarkers of neuronal excitability related to the EZN and will add additional information to VEP estimation. In this paper, we first proposed the mapping from 23 Na-MRI features to predict the EZN via a machine learning approach. Then, we exploited these predictions as priors in the VEP pipeline. The statistical results demonstrated that compared with the results from current VEP, the result from VEP based on 23 Na-MRI prior has better balanced accuracy, and the similar weighted harmonic mean of the precision and recall. Author Summary For the first time quantitative 23 Na-MRI were used as prior information to improve estimation of epileptogenic network (EZN) using VEP pipeline, a personalized whole-brain network modeling from patient’s specific data. The prior information of EZN can be derived from 23 Na-MRI features using logistic regression predictions. The 23 Na-MRI priors inferred EZNs has a better balanced accuracy than the previously used priors or the no-prior condition.

Whole-brain functional connectivity networks (connectomes) have been characterized at different scales in humans using EEG and fMRI. Multimodal epileptic networks have also been investigated, but the relationship between EEG and fMRI defined networks on a whole-brain scale is unclear. A unified multimodal connectome description, mapping healthy and pathological networks would close this knowledge gap. Here, we characterize the spatial correlation between the EEG and fMRI connectomes in right and left temporal lobe epilepsy (rTLE/lTLE). From two centers, we acquired resting-state concurrent EEG-fMRI of 35 healthy controls and 34 TLE patients. EEG-fMRI data was projected into the Desikan brain atlas, and functional connectomes from both modalities were correlated. EEG and fMRI connectomes were moderately correlated. This correlation was increased in rTLE when compared to controls for EEG-delta/theta/alpha/beta. Conversely, multimodal correlation in lTLE was decreased in respect to controls for EEG-beta. While the alteration was global in rTLE, in lTLE it was locally linked to the default mode network. The increased multimodal correlation in rTLE and decreased correlation in lTLE suggests a modality-specific lateralized differential reorganization in TLE, which needs to be considered when comparing results from different modalities. Each modality provides distinct information, highlighting the benefit of multimodal assessment in epilepsy. Author Summary The relationship between resting-state hemodynamic (fMRI) and electrophysiological (EEG) connectivity has been investigated in healthy subjects, but this relationship is unknown in patients with left and right temporal lobe epilepsies (l/rTLE). Does the magnitude of the relationship differ between healthy subjects and patients? What role does the laterality of the epileptic focus play? What are the spatial contributions to this relationship? Here we use concurrent EEG-fMRI recordings of 65 subjects from two centers (35 controls, 34 TLE patients), to assess the correlation between EEG and fMRI connectivity. For all datasets, frequency-specific changes in cross-modal correlation were seen in lTLE and rTLE. EEG and fMRI connectivities do not measure perfectly overlapping brain networks and provide distinct information on brain networks altered in TLE, highlighting the benefit of multimodal assessment to inform about normal and pathological brain function.