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

Lene Duez; Hatice Tankisi; Peter Orm Hansen; Per Christian Sidenius; Anne Sabers; Lars Hageman  Pinborg; Martin Ejler Fabricius; György  Rásonyi; Guido Rubboli; Birthe Pedersen; Anne-Mette Leffers; Peter Uldall; Bo Jespersen; Jannick Brennum; Otto Mølby Henriksen; Anders Fuglsang-Frederiksen; Sándor Beniczky

doi:10.1212/WNL.0000000000006877

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

Lene Duez, Hatice Tankisi, Peter Orm Hansen, Per Christian Sidenius, Anne Sabers, Lars Hageman Pinborg, Martin Ejler Fabricius, György Rásonyi, Guido Rubboli, Birthe Pedersen, Anne-Mette Leffers, Peter Uldall, Bo Jespersen, Jannick Brennum, Otto Mølby Henriksen, Anders Fuglsang-Frederiksen, Sándor Beniczky

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

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Abstract

Objective To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.MethodsWe 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.ResultsWe 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.ConclusionEMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.Classification of evidenceThis 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.

Originalsprog	Engelsk
Tidsskrift	Neurology
Vol/bind	92
Nummer	6
Sider (fra-til)	e576-e586
Antal sider	12
ISSN	0028-3878
DOI	https://doi.org/10.1212/WNL.0000000000006877
Status	Udgivet - 5 feb. 2019

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10.1212/WNL.0000000000006877

e576.fullForlagets udgivne version, 764 KBLicens: CC BY-NC-ND

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Duez, L., Tankisi, H., Hansen, P. O., Sidenius, P. C., Sabers, A., Pinborg, L. H., Fabricius, M. E., Rásonyi, G., Rubboli, G., Pedersen, B., Leffers, A.-M., Uldall, P., Jespersen, B., Brennum, J., Henriksen, O. M., Fuglsang-Frederiksen, A., & Beniczky, S. (2019). Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study. Neurology, 92(6), e576-e586. https://doi.org/10.1212/WNL.0000000000006877

@article{79a0a88e1241446a81946761d7387d92,

title = "Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study",

abstract = "Objective To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.MethodsWe 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.ResultsWe 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.ConclusionEMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.Classification of evidenceThis 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.",

author = "Lene Duez and Hatice Tankisi and Hansen, {Peter Orm} and Sidenius, {Per Christian} and Anne Sabers and Pinborg, {Lars Hageman} and Fabricius, {Martin Ejler} and Gy{\"o}rgy R{\'a}sonyi and Guido Rubboli and Birthe Pedersen and Anne-Mette Leffers and Peter Uldall and Bo Jespersen and Jannick Brennum and Henriksen, {Otto M{\o}lby} and Anders Fuglsang-Frederiksen and S{\'a}ndor Beniczky",

year = "2019",

month = feb,

day = "5",

doi = "10.1212/WNL.0000000000006877",

language = "English",

volume = "92",

pages = "e576--e586",

journal = "Neurology",

issn = "0028-3878",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

}

Duez, L , Tankisi, H, Hansen, PO, Sidenius, PC, Sabers, A, Pinborg, LH, Fabricius, ME, Rásonyi, G, Rubboli, G, Pedersen, B, Leffers, A-M, Uldall, P, Jespersen, B, Brennum, J, Henriksen, OM, Fuglsang-Frederiksen, A & Beniczky, S 2019, 'Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study', Neurology, bind 92, nr. 6, s. e576-e586. https://doi.org/10.1212/WNL.0000000000006877

TY - JOUR

T1 - Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study

AU - Duez, Lene

AU - Tankisi, Hatice

AU - Hansen, Peter Orm

AU - Sidenius, Per Christian

AU - Sabers, Anne

AU - Pinborg, Lars Hageman

AU - Fabricius, Martin Ejler

AU - Rásonyi, György

AU - Rubboli, Guido

AU - Pedersen, Birthe

AU - Leffers, Anne-Mette

AU - Uldall, Peter

AU - Jespersen, Bo

AU - Brennum, Jannick

AU - Henriksen, Otto Mølby

AU - Fuglsang-Frederiksen, Anders

AU - Beniczky, Sándor

PY - 2019/2/5

Y1 - 2019/2/5

N2 - Objective To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.MethodsWe 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.ResultsWe 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.ConclusionEMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.Classification of evidenceThis 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.

AB - Objective To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.MethodsWe 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.ResultsWe 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.ConclusionEMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.Classification of evidenceThis 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.

U2 - 10.1212/WNL.0000000000006877

DO - 10.1212/WNL.0000000000006877

M3 - Journal article

C2 - 30610090

SN - 0028-3878

VL - 92

SP - e576-e586

JO - Neurology

JF - Neurology

IS - 6

ER -

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

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