Preoperative Assessment in Temporal Lobe Epilepsy: Integrating EEG with Cortical Structural and Perfusion Metrics to Identify Cortical Damage

Motivation: Temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) presents diverse EEG expressions, complicating preoperative evaluations. Goal(s): To provide a comprehensive preoperative assessment by combining EEG with cortical structural and functional metrics. Approach: Ninety-two HS patients and 60 healthy controls underwent MRI scans. Cortical thickness and cerebral blood flow (CBF) were measured and analyzed using FreeSurfer and ITK-SNAP. Results: Both EEG-T and EEG-NT groups showed decreased cortical thickness and CBF, particularly in the frontal and temporal lobes, highlighting extensive cortical damage. Impact: This study highlights the extensive cortical damage in HS patients, particularly in the frontal and temporal lobes, guiding early surgical interventions. It enables clinicians to refine preoperative assessments and encourages further research on targeted therapies for improved patient outcomes.