A Patient-Specific Framework for Separating Temporal Localization from Intracranial Waveform Reconstruction of Interictal Epileptiform Discharges from Scalp EEG

Objective: We developed a patient-specific framework to determine which information about interictal epileptiform discharges (IEDs) can be recovered from scalp EEG, separating temporal localization (where) from event-specific intracranial waveform reconstruction (what). Methods: Six subjects from a public simultaneous high-density scalp EEG and intracranial EEG (iEEG) dataset were analyzed using patient-specific dual-branch convolutional-attention models integrating waveform/topographic and time-frequency representations. For the where task, a 640-ms scalp EEG segment was divided into eight 80-ms bins, and the model predicted the bin containing the intracranial IED peak. For the what task, a 250-ms peak-centered iEEG waveform was represented as a fixed patient-specific template plus an event-specific residual predicted from scalp EEG. Direct scalp-input controls and event-clustered bootstrap confidence intervals were used to distinguish scalp-dependent information from template-driven performance. Results: Where accuracy varied markedly across subjects (0.080-0.984), with an unweighted subject-level mean of 0.333 versus a chance level of 0.125; 95% confidence intervals were above chance level in three of six subjects. Input-control analyses supported a scalp-dependent contribution in subjects with successful localization. For the what task, mean waveform correlation was 0.752 for the model and 0.754 for the fixed patient-specific template (mean difference, -0.002), while residual correlations were generally modest (-0.020 to 0.378). Conclusion: Scalp EEG contained recoverable temporal information in some subjects, but event-specific single-contact morphology was not consistently recovered beyond the patient-specific template. Separating temporal localization from template-based waveform reconstruction provides a more stringent framework for evaluating noninvasive-to-intracranial inference and reduces conflation of prior-driven similarity with input-dependent reconstruction.