Premium
Predictive Value of MRI‐Identified Mesial Temporal Sclerosis for Surgical Outcome in Temporal Lobe Epilepsy: An Intent‐to‐Treat Analysis
Author(s) -
Gilliam F.,
Faught E.,
Martin R.,
Bowling S.,
Bilir E.,
Thomas J.,
Morawetz R.,
Kuzniecky R.
Publication year - 2000
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/j.1528-1157.2000.tb00279.x
Subject(s) - anterior temporal lobectomy , magnetic resonance imaging , predictive value , temporal lobe , ictal , mesial temporal lobe epilepsy , epilepsy , medicine , epilepsy surgery , predictive value of tests , retrospective cohort study , central nervous system disease , radiology , surgery , psychology , psychiatry
Summary:Purpose : Magnetic resonance imaging (MRI) accurately identifies mesial temporal selerosis (MTS), but prediction of successful surgical outcome ranges from 62% to 96% in published studies. Prior investigations only used patients who had received anterior temporal lobectomy (ATL), potentially overestimating the predictive value of MRI‐identified MTS (MRI‐MTS). Methods : The authors performed an intent‐to‐treat analysis of 90 consecutive patients assessed for possible ATL, including 13 who did not undergo ATL because of inconclusive intracranial ictal EEG. Four (31%) of these 13 patients had unilateral mesial temporal abnormalities on their MRIs. Results : The positive predictive value of MRI‐MTS for seizure cessation decreased from 0.69 to 0.63 after adjustment for these additional false positive results. Four previous studies had revealed a positive predictive value of 0.75 (0.72 after similar adjustment). Conclusions : The authors conclude that the predictive value of MRI‐MTS for outcome from ATL may be overestimated by small retrospective studies of highly selected postoperative patients.