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Type: Artigo
Title: EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy
Author: Coan, A. C.
Chaudhary, U. J.
Grouiller, F.
Campos, B. M.
Perani, S.
De Ciantis, A.
Vulliemoz, S.
Diehl, B.
Beltramini, G. C.
Carmichael, D. W.
Thornton, R. C.
Covolan, R. J.
Cendes, F.
Lemieux, L.
Abstract: Objective Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome. Methods 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during videoEEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection. Results The proportion of patients with good surgical outcome was significantly higher (13/16, 81%) in the Concordant than in the Discordant group (3/14, 21%) (chi(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively. Interpretation The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.
Subject: Imagem de ressonância magnética
Country: Reino Unido
Editor: BMJ Group
Citation: Journal Of Neurology Neurosurgery And Psychiatry. BMJ PUBLISHING GROUP, n. 87, n. 6, p. 642 - 649.
Rights: fechado
Identifier DOI: 10.1136/jnnp-2015-310401
Date Issue: 2016
Appears in Collections:IFGW - Artigos e Outros Documentos
FCM - Artigos e Outros Documentos

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