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Summary   Objective  Electrical source imaging ( ESI ) is used increasingly to estimate the epileptogenic zone ( EZ ) in patients with epilepsy. Directed functional connectivity ( DFC ) coupled to  ESI  helps to better characterize epileptic networks, but studies on interictal activity have relied on high‐density recordings. We investigated the accuracy of  ESI  and  DFC  for localizing the  EZ , based on low‐density clinical  electroencephalography (EEG) .    Methods  We selected patients with the following: (a) focal epilepsy, (b) interictal spikes on standard  EEG,  (c) either a focal structural lesion concordant with the electroclinical semiology or good postoperative outcome. In 34 patients (20  temporal lobe epilepsy [TLE] , 14  extra‐TLE [ETLE ]), we marked interictal spikes and estimated the cortical activity during each spike in 82 cortical regions using a patient‐specific head model and distributed linear inverse solution. DFC between brain regions was computed using Granger‐causal modeling followed by network topologic measures. The concordance with the presumed  EZ  at the sublobar level was computed using the epileptogenic lesion or the resected area in postoperative seizure‐free patients.    Results  ESI, summed outflow, and efficiency were concordant with the presumed  EZ  in 76% of the patients, whereas the clustering coefficient and betweenness centrality were concordant in 70% of patients. There was no significant difference between  ESI  and connectivity measures. In all measures, patients with  TLE  had a significantly higher ( P  < 0.05) concordance with the presumed EZ than patients with with ETLE. The brain volume accepted for concordance was significantly larger in  TLE .    Significance  ESI and DFC derived from low‐density  EEG  can reliably estimate the  EZ  from interictal spikes. Connectivity measures were not superior to  ESI  for  EZ  localization during interictal spikes, but the current validation of the localization of connectivity measure is promising for other applications.

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Interictal epileptogenic zone localization in patients with focal epilepsy using electric source imaging and directed functional connectivity from low‐density  EEG