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Neurology. 2019 Feb 5;92(6):e576-e586. doi: 10.1212/WNL.0000000000006877. Epub 2019 Jan 4.

Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study.

Author information

1
From the Departments of Clinical Neurophysiology (L.D., H.T., P.O.H., A.F.-F., S.B.) and Neurology (P.S.), Aarhus University Hospital; Departments of Neurology (A.S., L.H.P.), Clinical Neurophysiology (M.F., G. Rásonyi), Pediatrics, Child Neurology (P.U.), Neurosurgery (B.J., J.B.), and Clinical Physiology, Nuclear Medicine and PET (O.M.H.), Copenhagen University Hospital Rigshospitalet; Danish Epilepsy Centre (G. Rubboli, B.P., S.B.), Dianalund; and Department of Diagnostic Radiology (A.-M.L.), Hvidovre Hospital, Denmark.
2
From the Departments of Clinical Neurophysiology (L.D., H.T., P.O.H., A.F.-F., S.B.) and Neurology (P.S.), Aarhus University Hospital; Departments of Neurology (A.S., L.H.P.), Clinical Neurophysiology (M.F., G. Rásonyi), Pediatrics, Child Neurology (P.U.), Neurosurgery (B.J., J.B.), and Clinical Physiology, Nuclear Medicine and PET (O.M.H.), Copenhagen University Hospital Rigshospitalet; Danish Epilepsy Centre (G. Rubboli, B.P., S.B.), Dianalund; and Department of Diagnostic Radiology (A.-M.L.), Hvidovre Hospital, Denmark. sandor.beniczky@aarhus.rm.dk.

Abstract

OBJECTIVE:

To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.

METHODS:

We prospectively recorded magnetoencephalography (MEG) simultaneously with EEG and performed EMSI, comprising electric source imaging, magnetic source imaging, and analysis of combined MEG-EEG datasets, using 2 different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ), we used intracranial recordings and for localization accuracy, outcome 1 year after operation.

RESULTS:

We included 141 consecutive patients. EMSI showed localized epileptiform discharges in 94 patients (67%). Most of the epileptiform discharge clusters (72%) were identified by both modalities, 15% only by EEG, and 14% only by MEG. Agreement was substantial between inverse solutions and moderate between software packages. EMSI provided new information that changed the management plan in 34% of the patients, and these changes were useful in 80%. Depending on the method, EMSI had a concordance of 53% to 89% with IZ and 35% to 73% with SOZ. Localization accuracy of EMSI was between 44% and 57%, which was not significantly different from MRI (49%-76%) and PET (54%-85%). Combined EMSI achieved significantly higher odds ratio compared to electric source imaging and magnetic source imaging.

CONCLUSION:

EMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.

CLASSIFICATION OF EVIDENCE:

This study provides Class IV evidence that EMSI had a concordance of 53%-89% and 35%-73% (depending on analysis) for the localization of epileptic focus as compared with intracranial recordings-IZ and SOZ, respectively.

PMID:
30610090
PMCID:
PMC6382058
DOI:
10.1212/WNL.0000000000006877
[Indexed for MEDLINE]
Free PMC Article

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