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See detailElectrical Source Imaging in cortical malformation-related epilepsy : a prospective EEG-SEEG concordance study
RIKIR, Estelle ULg; KOESSLER, Laurent; GAVARET, Martine et al

in Epilepsia (2014), 55(6), 918-932

OBJECTIVE: Delineating the epileptogenic zone (EZ) in refractory epilepsy related to malformations of cortical development (MCD) often requires intracranial EEG recordings, especially in cases of negative ... [more ▼]

OBJECTIVE: Delineating the epileptogenic zone (EZ) in refractory epilepsy related to malformations of cortical development (MCD) often requires intracranial EEG recordings, especially in cases of negative MRI or discordant MRI and video-EEG findings. It is therefore crucial to promote the development of non-invasive methods such as electrical source imaging (ESI). We aimed to (i) analyze the localization concordance of ESI derived from interictal discharges and EZ estimated by stereo-electroencephalography (SEEG), (ii) compare the concordance of ESI, MRI and electro-clinical correlations (ECC) with SEEG-EZ, and (iii) assess ESI added value in the EZ localization. METHODS: We prospectively analyzed 28 consecutive patients undergoing presurgical investigation for MCD-related refractory epilepsy in 2009-2012. ESI derived from 64-channel scalp EEG was interpreted blinded to- and subsequently compared with SEEG estimated ΕZ. Anatomical concordance of ESI with SEEG-ΕZ was compared to that of video-EEG and MRI. We further assessed ESI added value to ECC and MRI. RESULTS: Twelve (43%) patients had temporal and 16 (57%) extratemporal epilepsy. MRI was negative in 11 (39%) and revealed a cortical malformation in 17 (61%). ESI was fully concordant with the EZ in ten (36%) and partly concordant in 15 (53%). ECC presented a full and partial concordance with EZ in 11% and 82% of cases respectively and MRI in 11% and 46% respectively. Of 11 patients with negative MRI, ESI was fully concordant with the EZ in seven (64%), partly concordant in four (36%). ESI correctly confirmed, restricted or added localizations to ECC and MRI in 12 of 28 patients (43%) and in eight of 11 patients (73%) with negative MRI. SIGNIFICANCE: ESI contributes to estimate the EZ in MCD-related epilepsy. The added value of ESI to ECC is particularly high in patients with MCD and negative MRI, who represent the most challenging cases for epilepsy surgery. [less ▲]

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