Agustina M Lascano1, Thomas Perneger2, Serge Vulliemoz1, Laurent Spinelli1, Valentina Garibotto3, Christian M Korff4, Maria I Vargas5, Christoph M Michel6, Margitta Seeck7. 1. Department of Neurology, Geneva University Hospitals, Switzerland. 2. Division of Clinical Epidemiology, Geneva University Hospitals, Switzerland. 3. Department of Nuclear Medicine, Geneva University Hospitals, Switzerland. 4. Child and Adolescent Department, Geneva University Hospitals, Switzerland. 5. Department of Neuroradiology, Geneva University Hospitals, Switzerland. 6. Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, Campus Biotech, University of Geneva, Switzerland. 7. Department of Neurology, Geneva University Hospitals, Switzerland. Electronic address: Margitta.Seeck@hcuge.ch.
Abstract
OBJECTIVE: Preoperative workup aims at localizing the epileptogenic focus to achieve postoperative seizure-freedom. We studied the predictive value of non-invasive techniques, i.e. structural magnetic resonance imaging [MRI], high-density electric source imaging [HD-ESI] and metabolic imaging (positron emission tomography [PET]; single-photon emission computed tomography [SPECT]), in surgically treated patients. METHODS: A prospective study of 190 epileptic operated patients, with >12 months follow-up and analyzed with state-of-the-art algorithms. 58 patients underwent all techniques. We computed sensitivity, specificity, predictive value and diagnostic odds ratio (OR) in relation to postoperative outcome. RESULTS: Of 190 patients, 148 (77.9%) were seizure-free at follow-up. Resection of the epileptogenic focus was associated with favorable postsurgical outcome (p<0.05). Among 58 patients who underwent all tests, only MRI and HD-ESI were favorable outcome predictors (MRI: OR 10.9, p=0.004; HD-ESI: OR 13.1, p=0.004). Patients with concordant structural MRI and HD-ESI results had 92.3% (24/26) probability of favorable outcome. When both results were negative, probability was 0% (0/5); and when they disagreed, it was 63.0% (17/27). CONCLUSIONS: Combination of MRI and HD-ESI offered the highest predictive value for postoperative seizure-freedom. SIGNIFICANCE: This finding highlights the added value of HD-ESI in the presurgical workup, in particular in combination with an informative MRI.
OBJECTIVE: Preoperative workup aims at localizing the epileptogenic focus to achieve postoperative seizure-freedom. We studied the predictive value of non-invasive techniques, i.e. structural magnetic resonance imaging [MRI], high-density electric source imaging [HD-ESI] and metabolic imaging (positron emission tomography [PET]; single-photon emission computed tomography [SPECT]), in surgically treated patients. METHODS: A prospective study of 190 epileptic operated patients, with >12 months follow-up and analyzed with state-of-the-art algorithms. 58 patients underwent all techniques. We computed sensitivity, specificity, predictive value and diagnostic odds ratio (OR) in relation to postoperative outcome. RESULTS: Of 190 patients, 148 (77.9%) were seizure-free at follow-up. Resection of the epileptogenic focus was associated with favorable postsurgical outcome (p<0.05). Among 58 patients who underwent all tests, only MRI and HD-ESI were favorable outcome predictors (MRI: OR 10.9, p=0.004; HD-ESI: OR 13.1, p=0.004). Patients with concordant structural MRI and HD-ESI results had 92.3% (24/26) probability of favorable outcome. When both results were negative, probability was 0% (0/5); and when they disagreed, it was 63.0% (17/27). CONCLUSIONS: Combination of MRI and HD-ESI offered the highest predictive value for postoperative seizure-freedom. SIGNIFICANCE: This finding highlights the added value of HD-ESI in the presurgical workup, in particular in combination with an informative MRI.
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