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Jamalipour Soufi G, Hekmat Nia A, Hajalikhani P, Mehvari‐Habibabadi J, Chit Saz N. Correlation of magnetic resonance spectroscopy and magnetic resonance imaging with findings of electroencephalography in patients with temporal lobe epilepsy. J Med Radiat Sci 2024; 71:51-56. [PMID: 37602723 PMCID: PMC10920944 DOI: 10.1002/jmrs.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/08/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION This research aimed to see how well magnetic resonance spectroscopy (MRS) could identify the lateralization side in individuals with temporal lobe epilepsy (TLE) compared to electroencephalography (EEG) and magnetic resonance imaging (MRI) results. METHODS Twenty-three individuals were included in this research and diagnosed with TLE (both clinically and by EEG). Clinical exams, interictal EEG, and MRI were performed on all patients. In addition, the individuals were also subjected to proton MRS. RESULTS The age range of 23 participants was 20-55 years (mean = 34.6 ± 8.5); 10 were male (44%), and 13 were female (56%). The right temporal lobe MRI showed a sensitivity and specificity of 60% and 55% for detecting mesial temporal lobe sclerosis (MTS) foci, respectively (positive predictive value (PPV) of 27% and negative predictive value (NPV) of 83%). MRI showed 83% sensitivity and 35% specificity for MTS foci in the left temporal lobe (PPV of 31% and NPV of 86%). MRS showed 61% sensitivity and 100% specificity in the right temporal lobe (PPV 100%) and 80% sensitivity and specificity in the left temporal lobe (PPV 100%) for identifying MTS foci. Overall, MRS (both left and right) results matched EEG findings. CONCLUSION MRS is a potential noninvasive neuroradiology technique for assessing epilepsy patients because it is more sensitive than structural MRI in identifying MTS. The results of the study overall appears to be of interest but still need further support from future studies with larger sample sizes.
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Affiliation(s)
| | - Ali Hekmat Nia
- Department of Radiology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Parvaneh Hajalikhani
- Department of Radiology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | | | - Navid Chit Saz
- Department of Radiology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
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Yan R, Zhang H, Wang J, Zheng Y, Luo Z, Zhang X, Xu Z. Application value of molecular imaging technology in epilepsy. IBRAIN 2021; 7:200-210. [PMID: 37786793 PMCID: PMC10528966 DOI: 10.1002/j.2769-2795.2021.tb00084.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common neurological disease with various seizure types, complicated etiologies, and unclear mechanisms. Its diagnosis mainly relies on clinical history, but an electroencephalogram is also a crucial auxiliary examination. Recently, brain imaging technology has gained increasing attention in the diagnosis of epilepsy, and conventional magnetic resonance imaging can detect epileptic foci in some patients with epilepsy. However, the results of brain magnetic resonance imaging are normal in some patients. New molecular imaging has gradually developed in recent years and has been applied in the diagnosis of epilepsy, leading to enhanced lesion detection rates. However, the application of these technologies in epilepsy patients with negative brain magnetic resonance must be clarified. Thus, we reviewed the relevant literature and summarized the information to improve the understanding of the molecular imaging application value of epilepsy.
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Affiliation(s)
- Rong Yan
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Qing Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Wang
- Prevention and Health Care, The Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yong‐Su Zheng
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhong Luo
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xia Zhang
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zu‐Cai Xu
- Department of NeurologyThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Liu D, Yang Y, Chen D, Wang Z, Guo D, Bao L, Dong J, Wang X, Qu X. Brain metabolic differences between temporal lobe epileptic seizures and organic non-epileptic seizures in postictal phase: a retrospective study with magnetic resonance spectroscopy. Quant Imaging Med Surg 2021; 11:3781-3791. [PMID: 34341749 DOI: 10.21037/qims-20-1147] [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: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is employed to investigate the brain metabolites differences between patients with temporal lobe epileptic seizures (TLES) and organic non-epileptic seizures (ONES) that appear to be epileptic seizures. Twenty-three patients with TLES and nine patients with ONES in postictal phase underwent MRS examinations on a clinical 1.5T system, with 15 healthy controls in comparison. Statistical analyses on the ratios of brain metabolites were performed using the Mann-Whitney U test with age as a covariate. The results showed that N-acetyl-aspartate/Creatine (NAA/Cr) ratio of patients with TLES was statistically different from that of patients with ONES in postictal phase, i.e., TLES 1.422±0.037, ONES 1.640±0.061, P=0.012 in left temporal pole, while TLES 1.470±0.052, ONES 1.687±0.084, P=0.023 in the right temporal pole. Besides, compared with healthy controls, patients with TLES in postictal phase present significant differences in ratios of NAA/Cr, N-acetyl-aspartate/Choline (NAA/Cho) and NAA/(Cho + Cr). Experimental results demonstrate that NAA/Cr can be used to discriminate TLES from ONES, which has not been found in the references to the best of our knowledge. Although a prospective controlled validation is needed in the future, this retrospective study reveals that MRS may provide useful metabolites information to facilitate the epilepsy diagnosis.
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Affiliation(s)
- Dongbao Liu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Yonggui Yang
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Dicheng Chen
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Zi Wang
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Di Guo
- School of Computer and Information Engineering, Xiamen University of Technology, Xiamen, China
| | - Lijun Bao
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jiyang Dong
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Xin Wang
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Xiaobo Qu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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Abstract
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
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Tan Z, Long X, Tian F, Huang L, Xie F, Li S. Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings. AJNR Am J Neuroradiol 2019; 40:245-252. [PMID: 30679211 DOI: 10.3174/ajnr.a5944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel 1H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations. MATERIALS AND METHODS Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel 1H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed. RESULTS Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05). CONCLUSIONS Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.
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Affiliation(s)
- Z Tan
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - X Long
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - F Tian
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - L Huang
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
| | - F Xie
- Radiology (F.X.), Xiangya Hospital, Central South University, Changsha, China
| | - S Li
- From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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Colon A, Osch MV, Buijs M, Grond J, Hillebrand A, Schijns O, Wagner G, Ossenblok P, Hofman P, Buchem M, Boon P. MEG-guided analysis of 7T-MRI in patients with epilepsy. Seizure 2018; 60:29-38. [DOI: 10.1016/j.seizure.2018.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022] Open
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Lee DH, Lee DW, Kwon JI, Woo CW, Kim ST, Lee JS, Choi CG, Kim KW, Kim JK, Woo DC. In Vivo Mapping and Quantification of Creatine Using Chemical Exchange Saturation Transfer Imaging in Rat Models of Epileptic Seizure. Mol Imaging Biol 2018; 21:232-239. [DOI: 10.1007/s11307-018-1243-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lee M, Yum MS, Woo DC, Shim WH, Ko TS, Velíšek L. In Vivo Multimodal Magnetic Resonance Imaging Changes After N-Methyl-d-Aspartate-Triggered Spasms in Infant Rats. Front Neurol 2018; 9:248. [PMID: 29713308 PMCID: PMC5911983 DOI: 10.3389/fneur.2018.00248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/28/2018] [Indexed: 01/31/2023] Open
Abstract
Objective Despite the serious neurodevelopmental sequelae of epileptic encephalopathy during infancy, the pathomechanisms involved remain unclear. To find potential biomarkers that can reflect the pathogenesis of epileptic encephalopathy, we explored the neurometabolic and microstructural sequelae after infantile spasms using a rat model of infantile spasms and in vivo magnetic resonance imaging techniques. Methods Rats prenatally exposed to betamethasone were subjected to three rounds of intraperitoneal N-methyl-d-aspartate (NMDA) triggering of spasms or received saline injections (controls) on postnatal days (P) 12, 13, and 15. Chemical exchange saturation transfer imaging of glutamate (GluCEST) were performed at P15 and 22 and diffusion tensor imaging and additional spectroscopy (1H-MRI/MRS) of the cingulate cortex were serially done at P16, 23, and 30 and analyzed. Pathological analysis and western blotting were performed with rats sacrificed on P35. Results Within 24 h of the three rounds of NMDA-induced spasms, there was an acute increase in the GluCEST (%) in the cortex, hippocampus, and striatum. When focused on the cingulate cortex, mean diffusivity (MD) was significantly decreased during the acute period after multiple spasms with an increase in γ-aminobutyric acid (GABA), glutamate, and glutamine N-acetylaspartate-plus-N-acetylaspartylglutamate (tNAA), total choline, and total creatine. The juvenile rats also showed decreased MD on diffusion tensor imaging and significant decreases in taurine, tNAA, and macromolecules-plus-lipids in the cingulate cortex. Pathologically, there was a significant reduction in glial fibrillary acidic protein, myelin basic protein, and neuronal nuclei expression in the cingulate cortex of rats with NMDA-induced spasms. Significance These neurometabolic and microstructural alterations after NMDA-triggered spasms might be potential imaging biomarkers of epileptic encephalopathy.
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Affiliation(s)
- Minyoung Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, South Korea.,Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Mi-Sun Yum
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, South Korea.,Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Dong-Cheol Woo
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Woo-Hyun Shim
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.,Department of Radiology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Tae-Sung Ko
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Libor Velíšek
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, United States.,Department of Pediatrics, New York Medical College, Valhalla, NY, United States.,Department of Neurology, New York Medical College, Valhalla, NY, United States
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Event-Associated Oxygen Consumption Rate Increases ca. Five-Fold When Interictal Activity Transforms into Seizure-Like Events In Vitro. Int J Mol Sci 2017; 18:ijms18091925. [PMID: 28880249 PMCID: PMC5618574 DOI: 10.3390/ijms18091925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 01/03/2023] Open
Abstract
Neuronal injury due to seizures may result from a mismatch of energy demand and adenosine triphosphate (ATP) synthesis. However, ATP demand and oxygen consumption rates have not been accurately determined, yet, for different patterns of epileptic activity, such as interictal and ictal events. We studied interictal-like and seizure-like epileptiform activity induced by the GABAA antagonist bicuculline alone, and with co-application of the M-current blocker XE-991, in rat hippocampal slices. Metabolic changes were investigated based on recording partial oxygen pressure, extracellular potassium concentration, and intracellular flavine adenine dinucleotide (FAD) redox potential. Recorded data were used to calculate oxygen consumption and relative ATP consumption rates, cellular ATP depletion, and changes in FAD/FADH2 ratio by applying a reactive-diffusion and a two compartment metabolic model. Oxygen-consumption rates were ca. five times higher during seizure activity than interictal activity. Additionally, ATP consumption was higher during seizure activity (~94% above control) than interictal activity (~15% above control). Modeling of FAD transients based on partial pressure of oxygen recordings confirmed increased energy demand during both seizure and interictal activity and predicted actual FAD autofluorescence recordings, thereby validating the model. Quantifying metabolic alterations during epileptiform activity has translational relevance as it may help to understand the contribution of energy supply and demand mismatches to seizure-induced injury.
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Aitouche Y, Gibbs SA, Gilbert G, Boucher O, Bouthillier A, Nguyen DK. Proton MR Spectroscopy in Patients with Nonlesional Insular Cortex Epilepsy Confirmed by Invasive EEG Recordings. J Neuroimaging 2017; 27:517-523. [PMID: 28318128 DOI: 10.1111/jon.12436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent studies suggest that a nonnegligible proportion of drug-resistant epilepsy surgery candidates have an epileptogenic zone that involves the insula. We aimed to examine the value of proton magnetic resonance spectroscopy (1 H-MRS) in identifying patients with insular cortex epilepsy. METHODS Patients with possible nonlesional drug-refractory insular epilepsy underwent a voxel-based 1 H-MRS study prior to an intracranial electroencephalographic (EEG) study. Patients were then divided into two groups based on invasive EEG findings: the insular group with evidence of insular seizures and the noninsular group with no evidence of insular seizures. Sixteen age-matched healthy controls were also scanned for normative data. RESULTS Twenty-two epileptic patients were recruited, 12 with insular seizures and 10 with extra-insular seizures. Ipsilateral and contralateral insular N-acetyl-aspartate concentrations ([NAA]) and NAA/Cr ratios were found to be similar in both patient groups. No significant differences in [NAA] or NAA/Cr ratios were found between the insular group, noninsular group, and healthy controls. [NAA] and NAA/Cr asymmetry indices correctly lateralized the seizure focus in only 16.7% and 0% of patients, respectively. CONCLUSIONS Our preliminary findings suggest that 1 H-MRS fares poorly in identifying patients with nonlesional insular epilepsy.
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Affiliation(s)
| | - Steve A Gibbs
- Department of Neurosciences, Université de Montréal, Canada.,Division of Neurology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare, Canada.,Department of Radiology, CHUM Notre-Dame, Université de Montréal, Canada
| | | | - Alain Bouthillier
- Division of Neurosurgery, CHUM Notre-Dame, Université de Montréal, Canada
| | - Dang Khoa Nguyen
- Department of Neurosciences, Université de Montréal, Canada.,Division of Neurology, CHUM Notre-Dame, Université de Montréal, Canada
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Muhlhofer W, Tan Y, Mueller SG, Knowlton R. MRI
‐negative temporal lobe epilepsy—What do we know? Epilepsia 2017; 58:727-742. [DOI: 10.1111/epi.13699] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wolfgang Muhlhofer
- University of California San Francisco (UCSF) San Francisco California U.S.A
- University of Alabama Birmingham (UAB) Birmingham Alabama U.S.A
| | - Yee‐Leng Tan
- University of California San Francisco (UCSF) San Francisco California U.S.A
- National Neuroscience Institute Singapore Singapore
| | - Susanne G. Mueller
- University of California San Francisco (UCSF) San Francisco California U.S.A
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco California U.S.A
- Department of Radiology UCSF San Francisco CaliforniaU.S.A
| | - Robert Knowlton
- University of California San Francisco (UCSF) San Francisco California U.S.A
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Rincon SP, Blitstein MBK, Caruso PA, González RG, Thibert RL, Ratai EM. The Use of Magnetic Resonance Spectroscopy in the Evaluation of Pediatric Patients With Seizures. Pediatr Neurol 2016; 58:57-66. [PMID: 26948493 DOI: 10.1016/j.pediatrneurol.2016.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective was to determine if it is useful to routinely add magnetic resonance spectroscopy (MRS) to magnetic resonance imaging (MRI) in the evaluation of seizure in the pediatric patient. Specifically, how often does MRS contribute information to conventional MRI? METHODS A retrospective search, over a period of 3 years, of patients <18 years of age who underwent both MRI and MRS as part of the evaluation of seizures yielded a total of 233 cases in 216 patients. The medical records were reviewed to determine how many patients carried a diagnosis relevant to seizures. The MRIs and MRSs were reviewed by two neuroradiologists and an MR physicist/spectroscopist who determined by consensus in how many cases MRS contributed information regarding management, diagnosis, or prognosis, in addition to the findings on MRI alone. RESULTS In 100 of 233 cases (43%), MRS contributed information additional to MRI. In 40 cases, MRS contributed information relevant to patient management by prompting an evaluation for an underlying inborn error of metabolism. MRS contributed information relevant to diagnosis in 24 of 100 cases (e.g., neoplasm versus dysplasia). MRS contributed information relevant to prognosis in 36 cases (e.g., hypoxic-ischemic injury). MRS added more information in cases where the patients had a diagnosis relevant to seizure before imaging. Interestingly, in 25 cases where the MRI was normal, MRS was found to be abnormal, which prompted evaluation for an inborn error of metabolism. CONCLUSIONS These results suggest that MRS is a useful evaluation tool in addition to MRI for children undergoing imaging for the evaluation of seizures.
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Affiliation(s)
- Sandra P Rincon
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marisa B K Blitstein
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul A Caruso
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - R Gilberto González
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald L Thibert
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eva-Maria Ratai
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Wang X, Zhang C, Wang Y, Hu W, Shao X, Zhang JG, Zhang K. Prognostic factors for seizure outcome in patients with MRI-negative temporal lobe epilepsy: A meta-analysis and systematic review. Seizure 2016; 38:54-62. [PMID: 27182689 DOI: 10.1016/j.seizure.2016.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to identify predictors of postoperative seizure freedom in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. METHOD Publications were screened from electronic databases (MEDLINE, EMBASE), epilepsy archives, and bibliographies of relevant articles that were written in English. We recorded all possible risk factors that might predict seizure outcome after surgery. We calculated odds ratio (OR) with corresponding 95% confidence intervals (95% CI) of predictors for postoperative seizure freedom. Heterogeneity was assessed with I(2). All meta-analyses were performed using Review Manager. RESULTS Epilepsy duration (OR=2.57, 95% CI=1.21-5.47, p<0.05, I(2)=1%) and ictal or interictal electroencephalographic anomalies precisely localized in the ipsilateral temporal lobe (OR=3.89, 95% CI=1.66-9.08, p<0.01, I(2)=0 and OR=3.38, 95% CI=1.57-7.25, p<0.05, I(2)=0, respectively) were significantly associated with a higher rate of seizure freedom after surgery. However, the positron emission tomography (PET) results were not predictive of postoperative seizure freedom (OR=2.11, 95% CI=0.95-4.65, p=0.06, I(2)=0). No significant difference in seizure freedom was observed between the positive and negative pathology groups (OR=1.36, 95% CI=0.70-2.63, p=0.36, I(2)=0). CONCLUSIONS A shorter epilepsy duration and scalp electroencephalogram (EEG) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy.
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Affiliation(s)
- Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China.
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