Effects of the spatial resolution of the Virtual Epileptic Patient on the identification of epileptogenic networks

Abstract

Abstract Digital twins play an increasing role in clinical decision making. This study evaluates a digital brain twin approach in presurgical evaluation, the Virtual Epileptic Patient (VEP), which estimates the epileptogenic zone in patients with drug-resistant epilepsy. We built the personalized digital brain twins of 14 patients and a series of synthetic dataset by considering different spatial configurations of the epileptogenic and/or propagation zone networks (EZN and PZN, respectively). Brain source signals were simulated with a high spatial resolution neural field model (NFM) composed of 81942 nodes, embedding both long-range (between brain regions) and short-range (within brain regions) coupling. Brain signals were then projected to stereotactic electroencephalographic (SEEG) contacts with an accurate forward solution. An inversion procedure based on a low spatial resolution neural mass model (NMM) composed of 162 nodes was applied to estimate the excitability of each region in each simulation. The ensuing estimated EZN/PZN was compared to the simulated ground truth by means of classification metrics. Overall, we observed correct but degraded performance when using an NMM to estimate the EZN from data simulated with an NFM, which was significant for the simplest spatial configurations. We quantified the reduced performance and demonstrated that the oversimplification of the forward problem is its principal cause. We showed that the absence of local coupling in the NMM affects the inversion process by an overestimation of the excitability, representing a significant clinical impact when using this procedure in the context of presurgical planning. In conclusion, this study highlighted the importance to shift from an NMM towards a full NFM modeling approach for the estimation of EZN, with a particularly relevant need when considering the most complex clinical cases.