Functional imaging: II. Prediction of epilepsy surgery outcome.

Academic Article

Abstract

  • 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.
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    Keywords

  • Adolescent, Adult, Brain, Child, Child, Preschool, Cohort Studies, Decision Support Techniques, Electroencephalography, Epilepsy, Female, Fluorodeoxyglucose F18, Humans, Infant, Male, Middle Aged, Patient Selection, Positron-Emission Tomography, Predictive Value of Tests, Preoperative Care, Prospective Studies, Tomography, Emission-Computed, Single-Photon, Treatment Outcome
  • Digital Object Identifier (doi)

    Author List

  • Knowlton RC; Elgavish RA; Bartolucci A; Ojha B; Limdi N; Blount J; Burneo JG; Ver Hoef L; Paige L; Faught E
  • Start Page

  • 35
  • End Page

  • 41
  • Volume

  • 64
  • Issue

  • 1