**5. Conclusions**

In conclusion, this study utilised a model to spatially map scalp electrodes to the nearest brain region and compare the structural and functional connectivity in nine patients with focal epilepsy. We showed that not all highly connected structural regions result in highly connected scalp EEG in the same region. Our findings suggest that seizures may follow strong connections intermittently and might only do so in well-lateralised patients and not for every seizure. Less well-lateralised patients displayed some high structure-function coupling in the ipsilateral hemisphere, but this was inconsistent. Our findings contribute to the evidence supporting the use of dMRI in clinical practice, which can guide patient-specific electrode placement and enhance the detection of the seizure onset zone. Future work will include comparisons with open source software and the addition of interictal and control data.

**Author Contributions:** Conceptualisation, C.M., C.W. and A.N.; methodology, C.M., C.W. and A.N.; clinical data acquisition, C.M. and A.N.; data curation, C.M. and A.D.; diffusion imaging pipeline, implementation and analysis, C.M., A.D. and C.W.; statistical analysis, C.M. and C.W.; manuscript writing, C.M.; manuscript revision and editing C.M., A.D., M.B., O.K., C.W. and A.N.; clinical advisory and results interpretation, A.N. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no specific external funding.

**Institutional Review Board Statement:** All research and methods were performed in accordance with the Declaration of Helsinki, and the relevant guidelines and regulations prescribed by the RPAH-LHD and ethics committees. The study was approved by the Ethics Committee from the RPAH Local Health District (RPAH-LHD). The protocol number and ethics approval ID for the MRI data are X14-0347 and HREC/14/RPAH/467. The protocol number and ethics approval ID for the EEG data are X19-0323 and 2019/ETH11868.

**Informed Consent Statement:** The requirement for informed consent was waived in the approved ethics for the EEG data (protocol number and approval ID are X19-0323 and 2019/ETH11868) since only de-identified EEG data was acquired. Written informed consent was obtained from all participants who attended the Brain and Mind Centre for an MRI scan, as per the approved MRI ethics (protocol number and approval ID are X14-0347 and HREC/14/RPAH/467).

**Data Availability Statement:** The datasets generated and/or analysed during the current study are not publicly available because they are RPAH patients and can only be accessed by authorised individuals named on the approved ethics. However, de-identified, processed data can be made available upon request to the corresponding author, and subject to approval from the governing ethics entities at the RPAH and The University of Sydney.

**Acknowledgments:** The Authors acknowledge all staff at the Comprehensive Epilepsy Centre at the RPAH, particularly Maricar Senturias (RN/ACNC Epilepsy), who assisted with patient recruitment. The Authors acknowledge the radiology staff at i-MED Radiology for their assistance in obtaining the MRI data. The Authors acknowledge the research funding support from UCB Australia Pty Ltd. C.M. acknowledges scholarship support from the Nerve Research Foundation, University of Sydney. A.D. acknowledges funding from St. Vincent's Hospital. O.K. acknowledges the partial support provided by The University of Sydney through a SOAR Fellowship and Microsoft's partial support through a Microsoft AI for Accessibility grant. CW acknowledges research funding from the Nerve Research Foundation, University of Sydney.

**Conflicts of Interest:** The Authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

**Appendix A**


 


**Figure A1.** Heatmaps of z-scores from MRI and EEG connectomes. L: Left, R: Right. Patients are numbered 1–9 above each "head" and their respective connectomes are shown below the "head" map in the same grouping as Figure 2 in the main text. The "EEG 1s windows" depict the left and right side of each EEG connectome, split into 1 s windows. The structural (MRI) connectomes are split into left and right sides ("L MRI" and "R MRI") and positioned alongside the matching EEG connectome side (i.e., left MRI next to left EEG connectome). The left and right electrode pairs are listed next to the respective side of the connectome.




