Premium
FDG ‐ PET and magnetoencephalography in presurgical workup of children with localization‐related nonlesional epilepsy
Author(s) -
Widjaja Elysa,
Shammas Amer,
Vali Reza,
Otsubo Hiroshi,
Ochi Ayako,
Snead O. Carter,
Go Cristina,
Charron Martin
Publication year - 2013
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12114
Subject(s) - magnetoencephalography , positron emission tomography , epilepsy , magnetic resonance imaging , nuclear medicine , epilepsy surgery , medicine , central nervous system disease , predictive value of tests , radiology , psychology , electroencephalography , surgery , psychiatry
Summary Purpose 2‐[18F]Fluoro‐2‐deoxy‐ d ‐glucose positron emission tomography ( FDG ‐ PET ) and magnetoencephalography ( MEG ) may assist in identifying the epileptogenic zone in children with nonlesional localization‐related epilepsy. The aim of this study was to evaluate sensitivity, specificity, positive predictive value ( PPV ), and negative predictive value ( NPV ) of FDG ‐ PET , MEG , FDG ‐ PET + MEG , and FDG ‐ PET / MEG in children with nonlesional localization‐related epilepsy. Methods Twenty‐six children with localization‐related epilepsy and who had normal or subtle changes on magnetic resonance imaging ( MRI ) underwent FDG ‐ PET and MEG . Twenty‐two patients had surgical resection, and surgical outcome was assessed using E ngel classification. In patients with E ngel I seizure outcome, we assessed the sensitivity, specificity, PPV , and NPV of lobar localization of MEG , FDG ‐ PET , FDG ‐ PET + MEG , and FDG ‐ PET / MEG . Key Findings Sixteen (72.7%) of 22 had E ngel I seizure outcome. MEG was concordant with surgical resection in 18 patients, 14 had E ngel I, and four had Engel II – IV outcomes. MEG was nonlocalizing or nonconcordant in four patients; two patients had E ngel I and two had Engel II – IV outcomes. FDG ‐ PET was concordant with surgical resection in 14 patients; 9 had E ngel I outcome, and 5 had E ngel II – IV outcome. FDG ‐ PET was nonlocalizing or nonconcordant in seven patients with E ngel I, and one with E ngel III outcome. The sensitivity, specificity, PPV , and NPV of MEG were 85.0%, 99.1%, 94.4%, and 97.3%, respectively. The sensitivity, specificity, PPV , and NPV of FDG ‐ PET were 65.0%, 94.4%, 68.4%, and 93.6%, respectively. There was no significant difference between MEG and FDG ‐ PET for concordance with surgical resection (χ 2 = 2.794, p = 0.095). FDG ‐ PET + MEG , defined as two tests concordant with surgical resection, had reduced sensitivity and NPV , but increased specificity and PPV (55.0%, 92.3%, 100%, and 100%, respectively) relative to individual tests. FDG ‐ PET / MEG , defined as one or both test(s) concordant with surgical resection, had increased sensitivity and NPV but reduced specificity (95.0%, 99.0%, and 93.5%, respectively) relative to individual tests. Significance The two tests FDG ‐ PET and MEG were complementary in the assessment of children with localization‐related epilepsy, particularly when one test was nonlocalizing or nonconcordant.