Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery
Summary Objective The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source ima...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2015-06, Vol.56 (6), p.949-958 |
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| creator | Englot, Dario J. Nagarajan, Srikantan S. Imber, Brandon S. Raygor, Kunal P. Honma, Susanne M. Mizuiri, Danielle Mantle, Mary Knowlton, Robert C. Kirsch, Heidi E. Chang, Edward F. |
| description | Summary
Objective
The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the presurgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long‐term seizure outcomes or small sample size.
Methods
We performed a retrospective cohort study of patients with focal epilepsy who received MEG for interictal spike mapping followed by surgical resection at our institution.
Results
We studied 132 surgical patients, with mean postoperative follow‐up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure‐free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (χ2 = 26.4, p |
| doi_str_mv | 10.1111/epi.13002 |
| format | Article |
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Objective
The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the presurgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long‐term seizure outcomes or small sample size.
Methods
We performed a retrospective cohort study of patients with focal epilepsy who received MEG for interictal spike mapping followed by surgical resection at our institution.
Results
We studied 132 surgical patients, with mean postoperative follow‐up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure‐free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (χ2 = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp electroencephalography (EEG), and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (95% confidence interval [CI] 2.23–11.8).
Significance
MEG is a valuable tool for noninvasive interictal spike mapping in epilepsy surgery, including patients with nonlocalized findings receiving long‐term EEG monitoring, and localization of the epileptogenic zone using MEG is associated with improved seizure outcomes.</description><identifier>ISSN: 0013-9580</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/epi.13002</identifier><identifier>PMID: 25921215</identifier><identifier>CODEN: EPILAK</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Brain Waves - physiology ; Chi-Square Distribution ; Cohort Studies ; Confidence intervals ; Electroencephalography ; Epilepsy ; Epilepsy - surgery ; Epileptogenic zone ; Female ; Humans ; Interictal spike ; Magnetic Resonance Imaging ; Magnetic source imaging ; Magnetoencephalography ; Male ; Predictive Value of Tests ; Reproducibility of Results ; Seizures - diagnosis ; Seizures - pathology ; Surgery ; Treatment Outcome</subject><ispartof>Epilepsia (Copenhagen), 2015-06, Vol.56 (6), p.949-958</ispartof><rights>Wiley Periodicals, Inc. © 2015 International League Against Epilepsy</rights><rights>Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.</rights><rights>Copyright © 2015 International League Against Epilepsy</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5792-7c11d5b510eeb160ce2282f56912d98523db976d44d0888b1ca1f24f1d8fcc4b3</citedby><cites>FETCH-LOGICAL-c5792-7c11d5b510eeb160ce2282f56912d98523db976d44d0888b1ca1f24f1d8fcc4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fepi.13002$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fepi.13002$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25921215$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Englot, Dario J.</creatorcontrib><creatorcontrib>Nagarajan, Srikantan S.</creatorcontrib><creatorcontrib>Imber, Brandon S.</creatorcontrib><creatorcontrib>Raygor, Kunal P.</creatorcontrib><creatorcontrib>Honma, Susanne M.</creatorcontrib><creatorcontrib>Mizuiri, Danielle</creatorcontrib><creatorcontrib>Mantle, Mary</creatorcontrib><creatorcontrib>Knowlton, Robert C.</creatorcontrib><creatorcontrib>Kirsch, Heidi E.</creatorcontrib><creatorcontrib>Chang, Edward F.</creatorcontrib><title>Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery</title><title>Epilepsia (Copenhagen)</title><addtitle>Epilepsia</addtitle><description>Summary
Objective
The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the presurgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long‐term seizure outcomes or small sample size.
Methods
We performed a retrospective cohort study of patients with focal epilepsy who received MEG for interictal spike mapping followed by surgical resection at our institution.
Results
We studied 132 surgical patients, with mean postoperative follow‐up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure‐free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (χ2 = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp electroencephalography (EEG), and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (95% confidence interval [CI] 2.23–11.8).
Significance
MEG is a valuable tool for noninvasive interictal spike mapping in epilepsy surgery, including patients with nonlocalized findings receiving long‐term EEG monitoring, and localization of the epileptogenic zone using MEG is associated with improved seizure outcomes.</description><subject>Adult</subject><subject>Brain Waves - physiology</subject><subject>Chi-Square Distribution</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Electroencephalography</subject><subject>Epilepsy</subject><subject>Epilepsy - surgery</subject><subject>Epileptogenic zone</subject><subject>Female</subject><subject>Humans</subject><subject>Interictal spike</subject><subject>Magnetic Resonance Imaging</subject><subject>Magnetic source imaging</subject><subject>Magnetoencephalography</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Reproducibility of Results</subject><subject>Seizures - diagnosis</subject><subject>Seizures - pathology</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0013-9580</issn><issn>1528-1167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi1ERbeFAy-ALHGhh7QeJ06cCxKqFqhUqT2Us-U4k6yrxA52Aso-PW63VICEL3Pwp0__zE_IW2DnkN4FTvYccsb4C7IBwWUGUFYvyYYxyLNaSHZMTmK8Z4xVZZW_Isdc1Bw4iA2x28kOOM2-R2cN3XuHdPBGD3avZ-sdXaJ1PR1173D26AxOOz34Puhpt9IpYGvNHGlEu18C0i4gtn6k1lF8FMeVxiX0GNbX5KjTQ8Q3T_OUfPu8vbv8ml3ffLm6_HSdGVHVPKsMQCsaAQyxgZIZ5FzyTpQ18LaWgudtU1dlWxQtk1I2YDR0vOiglZ0xRZOfko8H77Q0I7YG3Rz0oKZgRx1W5bVVf_84u1O9_6GKQlRlzZLgw5Mg-O8LxlmNNhocBu3QL1FBKcsCOAeZ0Pf_oPd-CS6t90CJUhYpYqLODpQJPsaA3XMYYOqhQJVupR4LTOy7P9M_k78bS8DFAfiZzrv-36S2t1cH5S-wy6f-</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Englot, Dario J.</creator><creator>Nagarajan, Srikantan S.</creator><creator>Imber, Brandon S.</creator><creator>Raygor, Kunal P.</creator><creator>Honma, Susanne M.</creator><creator>Mizuiri, Danielle</creator><creator>Mantle, Mary</creator><creator>Knowlton, Robert C.</creator><creator>Kirsch, Heidi E.</creator><creator>Chang, Edward F.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201506</creationdate><title>Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery</title><author>Englot, Dario J. ; Nagarajan, Srikantan S. ; Imber, Brandon S. ; Raygor, Kunal P. ; Honma, Susanne M. ; Mizuiri, Danielle ; Mantle, Mary ; Knowlton, Robert C. ; Kirsch, Heidi E. ; Chang, Edward F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5792-7c11d5b510eeb160ce2282f56912d98523db976d44d0888b1ca1f24f1d8fcc4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Brain Waves - physiology</topic><topic>Chi-Square Distribution</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Electroencephalography</topic><topic>Epilepsy</topic><topic>Epilepsy - surgery</topic><topic>Epileptogenic zone</topic><topic>Female</topic><topic>Humans</topic><topic>Interictal spike</topic><topic>Magnetic Resonance Imaging</topic><topic>Magnetic source imaging</topic><topic>Magnetoencephalography</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Reproducibility of Results</topic><topic>Seizures - diagnosis</topic><topic>Seizures - pathology</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Englot, Dario J.</creatorcontrib><creatorcontrib>Nagarajan, Srikantan S.</creatorcontrib><creatorcontrib>Imber, Brandon S.</creatorcontrib><creatorcontrib>Raygor, Kunal P.</creatorcontrib><creatorcontrib>Honma, Susanne M.</creatorcontrib><creatorcontrib>Mizuiri, Danielle</creatorcontrib><creatorcontrib>Mantle, Mary</creatorcontrib><creatorcontrib>Knowlton, Robert C.</creatorcontrib><creatorcontrib>Kirsch, Heidi E.</creatorcontrib><creatorcontrib>Chang, Edward F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epilepsia (Copenhagen)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Englot, Dario J.</au><au>Nagarajan, Srikantan S.</au><au>Imber, Brandon S.</au><au>Raygor, Kunal P.</au><au>Honma, Susanne M.</au><au>Mizuiri, Danielle</au><au>Mantle, Mary</au><au>Knowlton, Robert C.</au><au>Kirsch, Heidi E.</au><au>Chang, Edward F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery</atitle><jtitle>Epilepsia (Copenhagen)</jtitle><addtitle>Epilepsia</addtitle><date>2015-06</date><risdate>2015</risdate><volume>56</volume><issue>6</issue><spage>949</spage><epage>958</epage><pages>949-958</pages><issn>0013-9580</issn><eissn>1528-1167</eissn><coden>EPILAK</coden><abstract>Summary
Objective
The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables noninvasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the presurgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long‐term seizure outcomes or small sample size.
Methods
We performed a retrospective cohort study of patients with focal epilepsy who received MEG for interictal spike mapping followed by surgical resection at our institution.
Results
We studied 132 surgical patients, with mean postoperative follow‐up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure‐free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (χ2 = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp electroencephalography (EEG), and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (95% confidence interval [CI] 2.23–11.8).
Significance
MEG is a valuable tool for noninvasive interictal spike mapping in epilepsy surgery, including patients with nonlocalized findings receiving long‐term EEG monitoring, and localization of the epileptogenic zone using MEG is associated with improved seizure outcomes.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25921215</pmid><doi>10.1111/epi.13002</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Epilepsia (Copenhagen), 2015-06, Vol.56 (6), p.949-958 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Brain Waves - physiology Chi-Square Distribution Cohort Studies Confidence intervals Electroencephalography Epilepsy Epilepsy - surgery Epileptogenic zone Female Humans Interictal spike Magnetic Resonance Imaging Magnetic source imaging Magnetoencephalography Male Predictive Value of Tests Reproducibility of Results Seizures - diagnosis Seizures - pathology Surgery Treatment Outcome |
| title | Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery |
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