How wrong can we be? The effect of inaccurate mark-up of EEG/fMRI studies in epilepsy

Objective: The aim of this investigation was to determine the effect of inaccurate or inconsistent marking up of events in the EEG on statistical analysis of EEG/fMRI studies of patients with epilepsy. Methods: EEGs obtained during EEG/fMRI studies conducted on 10 patients with epilepsy and six normal control subjects were reviewed. All clear epileptiform events were marked up in the patient EEGs, as were all small movement-related artefacts in the patient and control subject EEGs. We then considered the effect on the numbers of voxels above threshold in the resulting Statistical Parametric Mapping (SPM) analysis if events were omitted, mislabelled, or if event times were inconsistently marked up. Results: Omitting true epileptiform events resulted in a decrease in the number of voxels that survive statistical threshold. Mixing epileptiform and non-epileptiform events in the SPM analysis generally (but not always) decreased the number of voxels that survived threshold. Inconsistent event mark-up had little effect if the inconsistency was small (<200 ms), but had more effect if it was large (>500 ms). Conclusion: It is important to accurately mark-up EEGs acquired during EEG/fMRI studies in order to get the best results from subsequent analyses. Significance: Our study reveals the consequences of inaccurate review of the EEG in EEG/fMRI studies and suggests guidelines for the review of EEG in these investigations which, if followed, should result in studies of acceptable quality. Crown Copyright (C) 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurobiology. All rights reserved.