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Li H, Meng Q, Liu Y, Wu H, Dong Y, Ren Y, Zhang J, Du C, Dong S, Liu X, Zhang H. The value of ictal scalp EEG in focal epilepsies surgery: a retrospective analysis. Neurol Sci 2024:10.1007/s10072-024-07657-8. [PMID: 38902569 DOI: 10.1007/s10072-024-07657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To describe the association between preoperative ictal scalp electroencephalogram (EEG) results and surgical outcomes in patients with focal epilepsies. METHODS The data of consecutive patients with focal epilepsies who received surgical treatments at our center from January 2012 to December 2021 were retrospectively analyzed. RESULTS Our data showed that 44.2% (322/729) of patients had ictal EEG recorded on video EEG monitoring during preoperative evaluation, of which 60.6% (195/322) had a concordant ictal EEG results. No significant difference of surgery outcomes between patients with and without ictal EEG was discovered. Among MRI-negative patients, those with concordant ictal EEG had a significantly better outcome than those without ictal EEG (75.7% vs. 43.8%, p = 0.024). Further logistic regression analysis showed that concordant ictal EEG was an independent predictor for a favorable outcome (OR = 4.430, 95%CI 1.175-16.694, p = 0.028). Among MRI-positive patients, those with extra-temporal lesions and discordant ictal EEG results had a worse outcome compared to those without an ictal EEG result (44.7% vs. 68.8%, p = 0.005). Further logistic regression analysis showed that discordant ictal EEG was an independent predictor of worse outcome (OR = 0.387, 95%CI 0.186-0.807, p = 0.011) in these patients. Furthermore, our data indicated that the number of seizures was not associated with the concordance rates of the ictal EEG, nor the surgical outcomes. CONCLUSIONS The value of ictal scalp EEG for epilepsy surgery varies widely among patients. A concordant ictal EEG predicts a good surgical outcome in MRI-negative patients, whereas a discordant ictal EEG predicts a poor postoperative outcome in lesional extratemporal lobe epilepsy.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Qiang Meng
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Yong Liu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Hao Wu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yicong Dong
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yutao Ren
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
| | - Jiale Zhang
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
| | - Changwang Du
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Shan Dong
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Xiaofang Liu
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China
| | - Hua Zhang
- Department of Neurosurgery, Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, No.277, Yanta West Road, Xi'an, 710061, China.
- Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an, 710061, China.
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Wang Z, Guo J, van 't Klooster M, Hoogteijling S, Jacobs J, Zijlmans M. Prognostic Value of Complete Resection of the High-Frequency Oscillation Area in Intracranial EEG: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209216. [PMID: 38560817 PMCID: PMC11175645 DOI: 10.1212/wnl.0000000000209216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES High-frequency oscillations (HFOs; ripples 80-250 Hz; fast ripples [FRs] 250-500 Hz) recorded with intracranial electrodes generated excitement and debate about their potential to localize epileptogenic foci. We performed a systematic review and meta-analysis on the prognostic value of complete resection of the HFOs-area (crHFOs-area) for epilepsy surgical outcome in intracranial EEG (iEEG) accessing multiple subgroups. METHODS We searched PubMed, Embase, and Web of Science for original research from inception to October 27, 2022. We defined favorable surgical outcome (FSO) as Engel class I, International League Against Epilepsy class 1, or seizure-free status. The prognostic value of crHFOs-area for FSO was assessed by (1) the pooled FSO proportion after crHFOs-area; (2) FSO for crHFOs-area vs without crHFOs-area; and (3) the predictive performance. We defined high combined prognostic value as FSO proportion >80% + FSO crHFOs-area >without crHFOs-area + area under the curve (AUC) >0.75 and examined this for the clinical subgroups (study design, age, diagnostic type, HFOs-identification method, HFOs-rate thresholding, and iEEG state). Temporal lobe epilepsy (TLE) was compared with extra-TLE through dichotomous variable analysis. Individual patient analysis was performed for sex, affected hemisphere, MRI findings, surgery location, and pathology. RESULTS Of 1,387 studies screened, 31 studies (703 patients) met our eligibility criteria. Twenty-seven studies (602 patients) analyzed FRs and 20 studies (424 patients) ripples. Pooled FSO proportion after crHFOs-area was 81% (95% CI 76%-86%) for FRs and 82% (73%-89%) for ripples. Patients with crHFOs-area achieved more often FSO than those without crHFOs-area (FRs odds ratio [OR] 6.38, 4.03-10.09, p < 0.001; ripples 4.04, 2.32-7.04, p < 0.001). The pooled AUCs were 0.81 (0.77-0.84) for FRs and 0.76 (0.72-0.79) for ripples. Combined prognostic value was high in 10 subgroups: retrospective, children, long-term iEEG, threshold (FRs and ripples) and automated detection and interictal (FRs). FSO after complete resection of FRs-area (crFRs-area) was achieved less often in people with TLE than extra-TLE (OR 0.37, 0.15-0.89, p = 0.006). Individual patient analyses showed that crFRs-area was seen more in patients with FSO with than without MRI lesions (p = 0.02 after multiple correction). DISCUSSION Complete resection of the brain area with HFOs is associated with good postsurgical outcome. Its prognostic value holds, especially for FRs, for various subgroups. The use of HFOs for extra-TLE patients requires further evidence.
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Affiliation(s)
- Ziyi Wang
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Jiaojiao Guo
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maryse van 't Klooster
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Sem Hoogteijling
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Julia Jacobs
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maeike Zijlmans
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
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Yao Y, Wang X, Zhao B, Mo J, Guo Z, Yang B, Li Z, Fan X, Cai D, Sang L, Zheng Z, Shao X, Ai L, Hu W, Zhang C, Zhang K. Hypometabolic patterns are related to post-surgical seizure outcomes in focal cortical dysplasia: A semi-quantitative study. Epilepsia Open 2024; 9:653-664. [PMID: 38265725 PMCID: PMC10984320 DOI: 10.1002/epi4.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Fluorine-18-fluorodeoxyglucose-positron emission tomography (FDG-PET) is routinely used for presurgical evaluation in many epilepsy centers. Hypometabolic characteristics have been extensively examined in prior studies, but the metabolic patterns associated with specific pathological types of drug-resistant epilepsy remain to be fully defined. This study was developed to explore the relationship between metabolic patterns or characteristics and surgical outcomes in type I and II focal cortical dysplasia (FCD) patients based on results from a large cohort. METHODS Data from individuals who underwent epilepsy surgery from 2014 to 2019 with a follow-up duration of over 3 years and a pathological classification of type I or II FCD in our hospital were retrospectively analyzed. Hypometabolic patterns were quantitatively identified via statistical parametric mapping (SPM) and qualitatively analyzed via visual examination of PET-MRI co-registration images. Univariate analyses were used to explore the relationship between metabolic patterns and surgical outcomes. RESULTS In total, this study included data from 210 patients. Following SPM calculations, four hypometabolic patterns were defined including unilobar, multi-lobar, and remote patterns as well as cases where no pattern was evident. In type II FCD patients, the unilobar pattern was associated with the best surgical outcomes (p = 0.014). In visual analysis, single gyrus (p = 0.032) and Clear-cut hypometabolism edge (p = 0.040) patterns exhibited better surgery outcomes in the type II FCD group. CONCLUSIONS PET metabolic patterns are well-correlated with the prognosis of type II FCD patients. However, similar correlations were not observed in type I FCD, potentially owing to the complex distribution of the epileptogenic region. PLAIN LANGUAGE SUMMARY In this study, we demonstrated that FDG-PET was a crucial examination for patients with FCD, which was a common cause of epilepsy. We compared the surgical prognosis for patients with different hypometabolism distribution patterns and found that clear and focal abnormal region in PET was correlated with good surgical outcome in type II FCD patients.
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Affiliation(s)
- Yuan Yao
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Xiu Wang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Baotian Zhao
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Jiajie Mo
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Zhihao Guo
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Bowen Yang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Zilin Li
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Xiuliang Fan
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Du Cai
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Lin Sang
- Department of NeurosurgeryBeijing FengTai HospitalBeijingChina
| | - Zhong Zheng
- Department of NeurosurgeryBeijing FengTai HospitalBeijingChina
| | - Xiaoqiu Shao
- Department of NeurologyBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Lin Ai
- Department of Nuclear MedicineBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Wenhan Hu
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
| | - Chao Zhang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
| | - Kai Zhang
- Department of NeurosurgeryBeijing TianTan Hospital, Capital Medical UniversityBeijingChina
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