EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy.
- Coan AC Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil.
- Chaudhary UJ Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- Grouiller F Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland.
- Campos BM Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil.
- Perani S Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- De Ciantis A Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- Vulliemoz S EEG and Epilepsy Unit and Functional Brain Mapping Laboratory, Neurology Department, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland.
- Diehl B Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- Beltramini GC Neurophysics Group, Gleb Wataghin Physics Institute, University of Campinas, Campinas, Brazil.
- Carmichael DW Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- Thornton RC Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- Covolan RJ Neurophysics Group, Gleb Wataghin Physics Institute, University of Campinas, Campinas, Brazil.
- Cendes F Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil.
- Lemieux L Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
- 2015-07-29
Published in:
- Journal of neurology, neurosurgery, and psychiatry. - 2016
FUNCTIONAL IMAGING
IMAGE ANALYSIS
SURGERY
Adolescent
Adult
Brain Mapping
Child
Drug Resistant Epilepsy
Electroencephalography
Epilepsy, Temporal Lobe
Female
Follow-Up Studies
Hemodynamics
Humans
Image Enhancement
Magnetic Resonance Imaging
Male
Middle Aged
Outcome Assessment, Health Care
Oxygen
Predictive Value of Tests
Preoperative Care
Retrospective Studies
Temporal Lobe
Video Recording
Young Adult
English
OBJECTIVE
Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome.
METHODS
30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection.
RESULTS
The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively.
INTERPRETATION
The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.
Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome.
METHODS
30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection.
RESULTS
The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively.
INTERPRETATION
The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1136/jnnp-2015-310401
- PMID 26216941
- Persistent URL
- https://sonar.ch/global/documents/246104
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