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Accuracy of Interictal and Ictal Electric and Magnetic Source Imaging: A Systematic Review and Meta-Analysis

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DOI

  • Praveen Sharma, King Georges Med Univ, King George's Medical University, Dept Neurol
  • ,
  • Margitta Seeck, Univ Hosp Geneva, University of Geneva, EEG & Epilepsy Unit
  • ,
  • Sandor Beniczky

Background: Electric and magnetic source imaging methods (ESI, MSI) estimate the location in the brain of the sources generating the interictal epileptiform discharges (II-ESI, II-MSI) and the ictal activity (IC-ESI, IC-MSI). These methods provide potentially valuable clinical information in the presurgical evaluation of patients with drug-resistant focal epilepsy, evaluated for surgical therapy. In spite of the significant technical advances in this field, and the numerous papers published on clinical validation of these methods, ESI and MSI are still underutilized in most epilepsy centers performing a presurgical evaluation. Our goal was to review and summarize the published evidence on the diagnostic accuracy of interictal and ictal ESI and MSI in epilepsy surgery. Methods: We searched the literature for papers on ESI and MSI that specified the diagnostic reference standard as the site of resection and the postoperative outcome (seizure-freedom). We extracted data from the selected studies, to calculate the diagnostic accuracy measures. Results: Our search resulted in 797 studies; 48 studies fulfilled the selection criteria (25 ESI and 23 MSI studies), providing data from 1,152 operated patients (515 for II-ESI, 440 for II-MSI, 159 for IC-ESI, and 38 for IC-MSI). The sensitivity of source imaging methods was between 74 and 90% (highest for IC-ESI). The specificity of the source imaging methods was between 20 and 54% (highest for II-MSI). The overall accuracy was between 50 and 75% (highest for IC-ESI). Diagnostic Odds Ratio was between 0.8 (IC-MSI) and 4.02-7.9 (II-ESI <II-MSI <IC-ESI). Conclusions: Our systematic review and meta-analysis provides evidence for the accuracy of source imaging in presurgical evaluation of patients with drug-resistant focal epilepsy. These methods have high sensitivity (up to 90%) and diagnostic odds ratio (up to 7.9), but the specificity is lower (up to 54%). ESI and MSI should be included in the multimodal presurgical evaluation.

Original languageEnglish
Article number1250
JournalFrontiers in Neurology
Volume10
Number of pages12
ISSN1664-2295
DOIs
Publication statusPublished - 2019

    Research areas

  • EEG, epilepsy, ictal, interictal, MEG, presurgical evaluation, source imaging, source analysis, SOURCE LOCALIZATION, EPILEPSY SURGERY, PRESURGICAL EVALUATION, EPILEPTOGENIC ZONE, LESIONAL EPILEPSY, INTRACRANIAL EEG, CLINICAL-YIELD, LOBE EPILEPSY, MAGNETOENCEPHALOGRAPHY, ELECTROENCEPHALOGRAPHY

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