ArticleEpilepsia2026
Sleep magnetoencephalography enhances detection and source imaging of seizures and fast oscillations in focal cortical dysplasia.
Article in Epilepsia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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14 authors.
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Abstract
objectiveFocal cortical dysplasia (FCD) causes drug-resistant epilepsy requiring presurgical evaluation. Invasive electroencephalographic (EEG) studies demonstrate that sleep modulates epileptic activity, including interictal epileptiform discharges (IEDs), fast oscillations (FOs) in the beta (14-40 Hz) and gamma (40-80 Hz) frequency bands, and seizures. This study aimed to quantify sleep-associated changes in IEDs, FOs, and seizures in FCD patients using noninvasive magnetoencephalography (MEG).
methodsNineteen patients with FCD were prospectively recruited and underwent simultaneous MEG/EEG recordings lasting 89 ± 19 min during daytime sleep. Sleep stages were classified from the EEG. Beamformer source signals were computed from the MEG signal to enhance sensitivity for visual detection of IEDs, FOs in the beta and gamma frequency bands, and seizures. Magnetic source imaging (MSI) was performed using the Maximum Entropy on the Mean (MEM) method, which is particularly sensitive to the spatial extent of sources, enabling accurate localization of epileptic activity.
resultsN1 sleep was reached in 17 of 19 patients and N2 sleep in 14 of 19 patients. Compared to wakefulness, sleep recordings showed significantly higher rates of FOs and seizures (both p < .05), whereas IED rates showed nonsignificant trends. Ten patients demonstrated FOs or seizures, and 12 showed IEDs. MSI of IEDs demonstrated consistent accuracy across vigilance states, with median Euclidean distances of 12.74 mm (interquartile range [IQR] = 22.74) in wake and 8.34 mm (IQR = 27.58) in sleep, and no systematic amplitude or spatial extent changes. Wavelet-MEM enabled frequency-specific source imaging, with FOs and seizures localizing concordantly to FCD lesions in five of seven and seven of eight patients, respectively. SIGNIFICANCE: Daytime sleep MEG recordings are clinically feasible and significantly enhance the detection of seizures (37% of patients) and FOs compared to wakefulness. Sleep protocols enable noninvasive capture of ictal patterns-the gold standard for epileptogenic zone localization-alongside increased FO rates. These findings support incorporating sleep into standard MEG protocols for presurgical epilepsy evaluation.
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