Abstract
Objective: To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD).
Methods: We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (DSOZ) and resection (DRES). We estimated receiver operating characteristic (ROC) curves with Youden's index (J) to predict outcome.
Results: EMSI presented shorter DSOZ (15.18 ± 9.06 mm) and DRES (8.56 ± 6.24 mm) compared to ESI (DSOZ: 25.04 ± 16.20 mm, p < 0.009; DRES: 18.88 ± 17.30 mm, p < 0.03) and MSI (DSOZ: 23.37 ± 8.98 mm, p < 0.03; DRES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter DSOZ and DRES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering.
Conclusions: EMSI provides superior localization and improved predictive performance than individual modalities.
Significance: EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.
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Christos Papadelis, Ph.D., founding director of Neuroscience Research at Cook Children’s, and his team recently published an article in the scientific journal, Clinical Neurophysiology, entitled "Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia." Rupesh Kumar Chikara, Ph.D., a postdoctoral research fellow, served as first author. Due to significant interest in this article, the editor-in-chief selected a figure for the cover of the journal.
Focal cortical dysplasia (FCD) is the most common pathology in children with drug resistant epilepsy. Surgical resection of FCD can lead to seizure freedom or a significant decrease in the number of seizures. Several electrophysiological methods are currently used in the presurgical evaluation of these patients. The goal of these methods is to identify noninvasively, with high precision, the brain area that is responsible for the generation of clinical seizures. Among others, magnetoencephalography (MEG) and high-density electroencephalography (HD-EEG) contribute significantly to this process. MEG and HD-EEG measure the magnetic and electric activity that is generated by the human brain; yet, these methods present limitations when they are used in isolation. For example, MEG is unable to localize epileptic activity generated in deep areas of the brain. On the other hand, HD-EEG presents lower localization precision compared to MEG.
In the present article, Dr. Papadelis and his team propose the development of a novel electrophysiological method that combines information from these two neuroimaging modalities into a single fused solution. The research team analyzed data of simultaneous MEG and HD-EEG electrophysiological recordings from 23 children with FCD who were unable to control their seizures with drugs. They showed that the combined information from MEG and HD-EEG provides superior accuracy in localizing the epileptic activity compared to using the modalities in isolation. This accuracy was comparable to invasive methods, such as intracranial electroencephalography recordings. This new method will potentially have significant clinical impact since it may offer a precise localization of the brain area that is responsible for the generation of seizures. Also, it may predict the surgical outcomes of children who are unable to control their seizures with medication alone. The findings of this study are particularly important for patients who cannot handle invasive examinations, such as infants or young children with epilepsy.
The study is funded by Dr. Papadelis' RO1 grant from the National Institute of Neurological Disorders and Stroke and is in collaboration with Boston Children's Hospital and Harvard Medical School.
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