Semiautomated electric source imaging determines epileptogenicity of encephaloceles in temporal lobe epilepsy
Epilepsia, vol. 65, pp. 651–663
Abstract
OBJECTIVE: We aimed to assess the ability of semiautomated electric source imaging (ESI) from long-term video-electroencephalographic (EEG) monitoring (LTM) to determine the epileptogenicity of temporopolar encephaloceles (TEs) in patients with temporal lobe epilepsy. METHODS: We conducted a retrospective study involving 32 temporal lobe epilepsy patients with TEs as potentially epileptogenic lesions in structural magnetic resonance imaging scans. Findings were validated through invasive intracerebral stereo-EEG in six of 32 patients and postsurgical outcome after tailored resection of the TE in 17 of 32 patients. LTM (mean duration = 6 days) was performed using the 10/20 system with additional T1/T2 for all patients and sphenoidal electrodes in 23 of 32 patients. Semiautomated detection and clustering of interictal epileptiform discharges (IEDs) were carried out to create IED types. ESI was performed on the averages of the two most frequent IED types per patient, utilizing individual head models, and two independent inverse methods (sLORETA [standardized low-resolution brain electromagnetic tomography], MUSIC [multiple signal classification]). ESI maxima concordance and propagation in spatial relation to TEs were quantified for sources with good signal quality (signal-to-noise ratio > 2, explained signal > 60%). RESULTS: ESI maxima correctly colocalized with a TE in 20 of 32 patients (62.5%) either at the onset or half-rising flank of at least one IED type per patient. ESI maxima showed propagation from the temporal pole to other temporal or extratemporal regions in 14 of 32 patients (44%), confirming propagation originating in the area of the TE. The findings from both inverse methods validated each other in 14 of 20 patients (70%), and sphenoidal electrodes exhibited the highest signal amplitudes in 17 of 23 patients (74%). The concordance of ESI with the TE predicted a seizure-free postsurgical outcome (Engel I vs. >I) with a diagnostic odds ratio of 2.1. SIGNIFICANCE: Semiautomated ESI from LTM often successfully identifies the epileptogenicity of TEs and the IED onset zone within the area of the TEs. Additionally, it shows potential predictive power for postsurgical outcomes in these patients.
Authors 12
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University of Freiburg · University Medical Center Freiburg · Grigore T. Popa University of Medicine and Pharmacy
Affiliation as printed
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
I Neurology Clinic "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi Romania
Neurology Clinic Rehabilitation Clinical Hospital Iași Romania
University of Medicine and Pharmacy "Grigore T. Popa" Iasi Romania
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
I Neurology Clinic "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi Romania
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Department of Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
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University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology
Affiliation as printed
Department of Stereotactic and Functional Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
Fraunhofer Institute for Laser Technology Aachen Germany
Department of Stereotactic and Functional Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
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Affiliation as printed
Section II Acute Institute of Psychiatry "Socola" Iasi Romania
Section II Acute Institute of Psychiatry "Socola" Iasi Romania
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Grigore T. Popa University of Medicine and Pharmacy
Affiliation as printed
Neurology Clinic Rehabilitation Clinical Hospital Iași Romania
University of Medicine and Pharmacy "Grigore T. Popa" Iasi Romania
University of Medicine and Pharmacy "Grigore T. Popa" Iasi Romania
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Grigore T. Popa University of Medicine and Pharmacy
Affiliation as printed
I Neurology Clinic "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi Romania
University of Medicine and Pharmacy "Grigore T. Popa" Iasi Romania
I Neurology Clinic "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi Romania
University of Medicine and Pharmacy "Grigore T. Popa" Iasi Romania
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University Medical Center Freiburg
Affiliation as printed
Department of Neuroradiology University Hospital Freiburg Freiburg Germany
Department of Neuroradiology University Hospital Freiburg Freiburg Germany
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University Medical Center Freiburg
Affiliation as printed
Department of Neuroradiology University Hospital Freiburg Freiburg Germany
Department of Neuroradiology University Hospital Freiburg Freiburg Germany
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
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Marcel Heers corresponding
University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Faculty of Medicine Epilepsy Center, Medical Center–University of Freiburg Freiburg Germany
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