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Clin Neurophysiol. 2019 May;130(5):845-855. doi: 10.1016/j.clinph.2018.12.016. Epub 2019 Feb 8.

Diagnostic accuracy of interictal source imaging in presurgical epilepsy evaluation: A systematic review from the E-PILEPSY consortium.

Author information

1
Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
2
Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium.
3
National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom; Department of Clinical and Experimental Epilepsy, University College, London, UK.
4
Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon, Lyon, France.
5
Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
6
Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria.
7
Department of Neurosurgery, Clinic of Surgery and Neuroscience, Oslo University Hospital, Norway.
8
Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
9
EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Switzerland.
10
Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision Making and HTA, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
11
Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: k.braun@umcutrecht.nl.

Abstract

OBJECTIVE:

Interictal high resolution (HR-) electric source imaging (ESI) and magnetic source imaging (MSI) are non-invasive tools to aid epileptogenic zone localization in epilepsy surgery candidates. We carried out a systematic review on the diagnostic accuracy and quality of evidence of these modalities.

METHODS:

Embase, Pubmed and the Cochrane database were searched on 13 February 2017. Diagnostic accuracy studies taking post-surgical seizure outcome as reference standard were selected. Quality appraisal was based on the QUADAS-2 framework.

RESULTS:

Eleven studies were included: eight MSI (n = 267), three HR-ESI (n = 127) studies. None was free from bias. This mostly involved: selection of operated patients only, interference of source imaging with surgical decision, and exclusion of indeterminate results. Summary sensitivity and specificity estimates were 82% (95% CI: 75-88%) and 53% (95% CI: 37-68%) for overall source imaging, with no statistical difference between MSI and HR-ESI. Specificity is higher when partially concordant results were included as non-concordant (p < 0.05). Inclusion of indeterminate test results as non-concordant lowered sensitivity (p < 0.05).

CONCLUSIONS:

Source imaging has a relatively high sensitivity but low specificity for identification of the epileptogenic zone.

SIGNIFICANCE:

We need higher quality studies allowing unbiased test evaluation to determine the added value and diagnostic accuracy of source imaging in the presurgical workup of refractory focal epilepsy.

KEYWORDS:

Electroencephalography; Magnetoencephalography; Sensitivity; Source localization; Specificity; Surgery

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