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Czarnetzki C, Spinelli L, Huppertz HJ, Schaller K, Momjian S, Lobrinus J, Vargas MI, Garibotto V, Vulliemoz S, Seeck M. Yield of non-invasive imaging in MRI-negative focal epilepsy. J Neurol 2024; 271:995-1003. [PMID: 37907727 PMCID: PMC10827933 DOI: 10.1007/s00415-023-11987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The absence of MRI-lesion reduces considerably the probability of having an excellent outcome (International League Against Epilepsies [ILAE] class I-II) after epilepsy surgery. Surgical success in magnetic-resonance imaging (MRI)-negative cases relies therefore mainly on non-invasive techniques such as positron-emission tomography (PET), subtraction ictal/inter-ictal single-photon-emission-computed-tomography co-registered to MRI (SISCOM), electric source imaging (ESI) and morphometric MRI analysis (MAP). We were interested in identifying the optimal imaging technique or combination to achieve post-operative class I-II in patients with MRI-negative focal epilepsy. METHODS We identified 168 epileptic patients without MRI lesion. Thirty-three (19.6%) were diagnosed with unifocal epilepsy, underwent surgical resection and follow-up ⩾ 2 years. Sensitivity, specificity, predictive values, and diagnostic odds ratio (OR) were calculated for each technique individually and in combination (after co-registration). RESULTS 23/33 (70%) were free of disabling seizures (75.0% with temporal and 61.5% extratemporal lobe epilepsy). None of the individual modalities presented an OR > 1.5, except ESI if only patients with interictal epileptiform discharges (IEDs) were considered (OR 3.2). On a dual combination, SISCOM with ESI presented the highest outcome (OR = 6). MAP contributed to detecting indistinguishable focal cortical dysplasia in particular in extratemporal epilepsies with a sensitivity of 75%. Concordance of PET, ESI on interictal epileptic discharges, and SISCOM was associated with the highest chance for post-operative seizure control (OR = 11). CONCLUSION If MRI is negative, the chances to benefit from epilepsy surgery are almost as high as in lesional epilepsy, provided that multiple established non-invasive imaging tools are rigorously applied and co-registered together.
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Affiliation(s)
- Christian Czarnetzki
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Laurent Spinelli
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | | | - Karl Schaller
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Johannes Lobrinus
- Department of Clinical Pathology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Erkent I, Arslan GA, Saygi S, Irsel Tezer F. Subclinical seizures: The demographic data and scalp video-EEG findings, concordance with the epilepsy type and prognosis. Epilepsy Res 2023; 192:107142. [PMID: 37075526 DOI: 10.1016/j.eplepsyres.2023.107142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/01/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Subclinical seizures(SCSs) are overlooked in clinical practice. This study aims to investigate clinical, electrophysiological features of SCSs detected during video-electroencephalography(EEG) monitorization(VEM), concordance of the epilepsy type and SCSs, and predictors of the concordance. METHODS The data of drug-resistant epilepsy patients who had undergone video-EEG between 2010 and 2020 were investigated. Ictal activities showing temporospatial evolution lasted ≥ 10 s, without any behavioural changes were considered SCSs. Findings were re-evaluated for ictal localization, lateralization, ictal discharge type, vigilance status, and duration of SCSs to the accompaniment of clinical findings. Additionally, the concordance of epilepsy type and SCSs were analyzed. RESULTS Fifty-five SCSs were obtained in 24 of 804 patients (2,9 %) who were followed in the VEM unit; the epilepsy type of the patients was temporal in 26 and extratemporal lobe epilepsy in 29 SCSs. Among 55 SCSs recordings, 30 originated from the temporal lobe and 24 from the extratemporal lobe, and seizure localization could not be determined in one. The patients were younger, age at seizure onset was earlier, habitual seizures were more frequent, multiple anti-seizure drug use was higher, seizures more frequently occurred during sleep, cranial MR tended to be abnormal, patients were more likely to have a history of perinatal injury/head trauma, and the concordance of discharge patterns was lower in extratemporal SCSs.The concordance of epilepsy type with localization and lateralization of SCSs was not statistically significant. CONCLUSIONS SCSs originating from the temporal and extratemporal lobes might show similar characteristics with the epilepsy type, and SCSs might have clinical importance apart from epilepsy surgery.
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Affiliation(s)
- Irem Erkent
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Gokce Ayhan Arslan
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Saygi
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - F Irsel Tezer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Shih YC, Lee TH, Yu HY, Chou CC, Lee CC, Lin PT, Peng SJ. Machine Learning Quantitative Analysis of FDG PET Images of Medial Temporal Lobe Epilepsy Patients. Clin Nucl Med 2022; 47:287-293. [PMID: 35085166 PMCID: PMC8884180 DOI: 10.1097/rlu.0000000000004072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE 18F-FDG PET is widely used in epilepsy surgery. We established a robust quantitative algorithm for the lateralization of epileptogenic foci and examined the value of machine learning of 18F-FDG PET data in medial temporal lobe epilepsy (MTLE) patients. PATIENTS AND METHODS We retrospectively reviewed patients who underwent surgery for MTLE. Three clinicians identified the side of MTLE epileptogenesis by visual inspection. The surgical side was set as the epileptogenic side. Two parcellation paradigms and corresponding atlases (Automated Anatomical Labeling and FreeSurfer aparc + aseg) were used to extract the normalized PET uptake of the regions of interest (ROIs). The lateralization index of the MTLE-associated regions in either hemisphere was calculated. The lateralization indices of each ROI were subjected for machine learning to establish the model for classifying the side of MTLE epileptogenesis. RESULT Ninety-three patients were enrolled for training and validation, and another 11 patients were used for testing. The hit rate of lateralization by visual analysis was 75.3%. Among the 23 patients whose MTLE side of epileptogenesis was incorrectly determined or for whom no conclusion was reached by visual analysis, the Automated Anatomical Labeling and aparc + aseg parcellated the associated ROIs on the correctly lateralized MTLE side in 100.0% and 82.6%. In the testing set, lateralization accuracy was 100% in the 2 paradigms. CONCLUSIONS Visual analysis of 18F-FDG PET to lateralize MTLE epileptogenesis showed a lower hit rate compared with machine-assisted interpretation. While reviewing 18F-FDG PET images of MTLE patients, considering the regions associated with MTLE resulted in better performance than limiting analysis to hippocampal regions.
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Affiliation(s)
- Yen-Cheng Shih
- From the Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Brain Research Center, National Yang Ming Chiao Tung University
| | - Tse-Hao Lee
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Departments of Nuclear Medicine
| | - Hsiang-Yu Yu
- From the Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Brain Research Center, National Yang Ming Chiao Tung University
| | - Chien-Chen Chou
- From the Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Brain Research Center, National Yang Ming Chiao Tung University
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Brain Research Center, National Yang Ming Chiao Tung University
- Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Po-Tso Lin
- From the Department of Neurology, Neurological Institute, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine
- Brain Research Center, National Yang Ming Chiao Tung University
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Clinical value and predictors of subclinical seizures in patients with temporal lobe epilepsy undergoing scalp video-EEG monitoring. J Clin Neurosci 2017; 44:214-217. [DOI: 10.1016/j.jocn.2017.06.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/21/2017] [Indexed: 11/20/2022]
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Healy GM, Redmond CE, Kinsella J, Killeen RP. PET imaging of subclinical seizure associated with intracranial cavernous malformations. QJM 2017; 110:45-46. [PMID: 27803370 DOI: 10.1093/qjmed/hcw177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present the case of a subclinical seizure identified during positron emission tomography with 18-fluorodeoxyglucose in a patient with cavernous malformations.
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Affiliation(s)
- G M Healy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - C E Redmond
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - J Kinsella
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - R P Killeen
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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Abdulla S, Saada J, Johnson G, Jefferies S, Ajithkumar T. Tumour progression or pseudoprogression? A review of post-treatment radiological appearances of glioblastoma. Clin Radiol 2015; 70:1299-312. [PMID: 26272530 DOI: 10.1016/j.crad.2015.06.096] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/08/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
Glioblastoma (GBM) is a common brain tumour in adults, which, despite multimodality treatment, has a poor median survival. Efficacy of therapy is assessed by clinical examination and magnetic resonance imaging (MRI) features. There is now a recognised subset of treated patients with imaging features that indicate "progressive disease" according to Macdonald's criteria, but subsequently, show stabilisation or resolution without a change in treatment. In these cases of "pseudoprogression", it is believed that non-tumoural causes lead to increased contrast enhancement and conventional MRI is inadequate in distinguishing this from true tumour progression. Incorrect diagnosis is important, as failure to identify pseudoprogression could lead to an inappropriate change of effective therapy. The purpose of this review is to outline the current research into radiological assessment with MRI and molecular imaging of post-treatment GBMs, specifically the differentiation between pseudoprogression and tumour progression.
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Affiliation(s)
- S Abdulla
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - J Saada
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - G Johnson
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - S Jefferies
- Department of Oncology, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - T Ajithkumar
- Department of Oncology, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
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