Functional imaging: II. Prediction of epilepsy surgery outcome.

Full 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.

Author information

Author/s: Knowlton, Robert C (RC); Elgavish, Rotem A (RA); Bartolucci, Al (A); Ojha, Buddhiwardhan (B); Limdi, Nita (N); Blount, Jeffrey (J); Burneo, Jorge G (JG); Ver Hoef, Lawrence (L); Paige, Lebron (L); Faught, Edward (E); Kankirawatana, Pongkiat (P); Riley, Kristen (K); Kuzniecky, Ruben (R);

Affiliation: UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL 35294-0001, USA.

Grants: K23 NS02218 (Agency:NINDS NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Annals of neurology (Ann Neurol), published in United States. (Language: eng)

Reference: 2008-Jul; vol 64 (issue 1) : pp 35-41

Dates: Created 2008/08/05; Completed 2008/09/04;

PMID: 18570291, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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