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MONNERAT, B. Z. The convergence of long-term videoelectroencefalography and brain magnetic resonance imaging in the delineation of presumed extrahippocampal epileptogenic zones. 2016. 136 f. Tese (Doutorado) – Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2016. Patients with drug-resistant epilepsy frequently have extrahippocampal lesions as etiology. A large proportion of these patients might benefit from lesionectomy for the reduction of seizures. For surgery to be undertaken, it is usually performed both long-term videoelectroencephalography monitoring (VEEG) and magnetic resonance imaging of the brain (MRI) for the precise delimitation of the epileptogenic zone, the region that must be resected for seizure control. In the present study, the diagnostic accuracy of VEEG and MRI were studied in the localization of the epileptogenic zone in patients with focal cortical dysplasia. The seizure-onset zone (VEEG) and the region of epileptogenic lesion (MRI) were compared whereas concordant or discordant regarding surgery region. Medical charts of 209 patients were reviewed, being the reference standard (surgery region) and post-surgical follow-up longer than 12 months available in 43 patients. Videoelectroencephalography has a sensitivity of 85.7% (95% CI 62.6-96.2) and specificity of 41.1% (95% CI 19.4-66.5), with positive predictive value of 64.2% (95% CI 44.1-80.6) and negative predictive value of 70% (95% CI 35.3-91.9). Magnetic resonance imaging has a sensitivity of 91.6% (95% CI 71.5-98.5) and specificity of 36.8% (95% CI 17.2-61.3), with positive predictive value of 64.7% (95% CI 46.4-79.6) and negative predictive value of 77.7% (95% CI 40.1-96). The differences of sensitivity and specificity, areas under the ROC curves and Youden’s indexes were not significant. The concordance between the results of VEEG and MRI was moderate (k=0.599; p<0.01; 95% CI 0.468-0.730). Key-words: epilepsy. cortical dysplasia. videoelectroencephalography. magnetic resonance imaging. epilepsy surgery. accuracy. Lista de ilustrações Figura 1 – Imagem de ressonância magnética da displasia cortical focal, evidenciada por hipersinal na região temporal esquerda na sequência FLAIR (A,B) e hiposinal na região parietal direita na sequência T1 (C). Extraído de VELEZ-RUIZ; KLEIN, 2012. . . . . . . . . . . . . . . . . . . . . . . . 30 Figura 2 – Instrumento para captação de dados do prontuário médico. . . . . . . . 46 Figura 3 – Fluxo da amostra. VEEG: vídeoeletroencefalografia; DCF: displasia cortical focal; IRM: imagem de ressonância magnética de encéfalo; CIREP: Centro de Cirurgia de Epilepsia – HC USP Ribeirão. . . . . . 52 Figura 4 – Distribuição das idades à VEEG e à cirurgia. . . . . . . . . . . . . . . 53 Figura 5 – Duração da epilepsia à VEEG e à cirurgia. . . . . . . . . . . . . . . . . 54 Figura 6 – Fluxo de resultados para cálculos de acurácia. DCF: displasia cortical focal; IRM: imagem de ressonância magnética; VEEG: videoeletroencefalografia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Figura 7 – Curvas ROC (receiver-operating characteristic). . . . . . . . . . . . . . 68 Figura 8 – Cálculo do poder estatístico do estudo. . . . . . . . . . . . . . . . . . . 76

Convergência da videoeletroencefalografia prolongada e da ressonância magnética de encéfalo na determinação de zonas epileptogênicas extrahipocampais presumidas