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Functional imaging: II. Prediction of epilepsy surgery outcome
Author(s) -
Knowlton Robert C.,
Elgavish Rotem A.,
Bartolucci Al,
Ojha Buddhiwardhan,
Limdi Nita,
Blount Jeffrey,
Burneo Jorge G.,
Ver Hoef Lawrence,
Paige Lebron,
Faught Edward,
Kankirawatana Pongkiat,
Riley Kristen,
Kuzniecky Ruben
Publication year - 2008
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21419
Subject(s) - ictal , ictal interictal spect analysis by spm , positron emission tomography , epilepsy , medicine , epilepsy surgery , nuclear medicine , magnetic resonance imaging , electroencephalography , predictive value of tests , single photon emission computed tomography , prospective cohort study , emission computed tomography , radiology , psychiatry
Objective To gain information on the value of magnetic source imaging (MSI), 2‐[18F]fluoro‐2‐deoxy‐ D ‐glucose positron emission tomography (FDG‐PET), and ictal single photon emission computed tomography (SPECT) to predict seizure‐free outcome following epilepsy surgery in patients who require intracranial electroencephalography (ICEEG). Methods This work was part of a prospective observation study of epilepsy surgery candidates not sufficiently localized with scalp EEG and MRI. Of 160 patients enrolled 62 completed ICEEG and subsequent surgical resection. Sixty‐one percent resulted in an Engel I seizure‐free outcome at a minimum of one‐year follow‐up (mean = 3.4 years). Sensitivity, specificity, and predictive values were computed for each modality. Multivariate logistical regression was used to identify prediction of surgical outcome by imaging test. Results MSI sensitivity for a conclusively localized study was 55% with a positive predictive value of 78%. Eliminating non‐diagnostic MSI cases (no spikes captured during recording) yielded a corrected negative predictive value of 64%. With available comparison subgroups FDG‐PET and ictal SPECT values were similar to MSI. The OR (adjusted for epilepsy and MRI classification) for MSI prediction of seizure‐free outcome was 4.4 ( p =0.01). In cases with both PET and MSI, the adjusted OR for PET was 7.1 ( p <0.01) and for MSI was 6.4 ( p = 0.01). In the cases with all three tests (n = 27), ictal SPECT had the highest OR of 9.1 ( p = 0.05). Interpretation MSI, FDG‐PET, and ictal SPECT each have clinical value in predicting seizure‐free surgical outcome in epilepsy surgery candidates who typically require ICEEG. Ann Neurol 2008