Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study

Neurology. 2019 Feb 5;92(6):e576-e586. doi: 10.1212/WNL.0000000000006877. Epub 2019 Jan 4.

Abstract

Objective: To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.

Methods: We prospectively recorded magnetoencephalography (MEG) simultaneously with EEG and performed EMSI, comprising electric source imaging, magnetic source imaging, and analysis of combined MEG-EEG datasets, using 2 different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ), we used intracranial recordings and for localization accuracy, outcome 1 year after operation.

Results: We included 141 consecutive patients. EMSI showed localized epileptiform discharges in 94 patients (67%). Most of the epileptiform discharge clusters (72%) were identified by both modalities, 15% only by EEG, and 14% only by MEG. Agreement was substantial between inverse solutions and moderate between software packages. EMSI provided new information that changed the management plan in 34% of the patients, and these changes were useful in 80%. Depending on the method, EMSI had a concordance of 53% to 89% with IZ and 35% to 73% with SOZ. Localization accuracy of EMSI was between 44% and 57%, which was not significantly different from MRI (49%-76%) and PET (54%-85%). Combined EMSI achieved significantly higher odds ratio compared to electric source imaging and magnetic source imaging.

Conclusion: EMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.

Classification of evidence: This study provides Class IV evidence that EMSI had a concordance of 53%-89% and 35%-73% (depending on analysis) for the localization of epileptic focus as compared with intracranial recordings-IZ and SOZ, respectively.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Electroencephalography
  • Epilepsy / diagnostic imaging*
  • Epilepsy / physiopathology
  • Epilepsy / surgery
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Magnetoencephalography
  • Male
  • Middle Aged
  • Neuroimaging
  • Neurosurgical Procedures
  • Positron-Emission Tomography
  • Prospective Studies
  • Treatment Outcome
  • Young Adult