PT  - JOURNAL ARTICLE
AU  - Coan, Ana C
AU  - Chaudhary, Umair J
AU  - Frédéric Grouiller,
AU  - Campos, Brunno M
AU  - Perani, Suejen
AU  - De Ciantis, Alessio
AU  - Vulliemoz, Serge
AU  - Diehl, Beate
AU  - Beltramini, Guilherme C
AU  - Carmichael, David W
AU  - Thornton, Rachel C
AU  - Covolan, Roberto J
AU  - Cendes, Fernando
AU  - Lemieux, Louis
TI  - EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy
AID  - 10.1136/jnnp-2015-310401
DP  - 2016 Jun 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 642--649
VI  - 87
IP  - 6
4099  - http://jnnp.bmj.com/content/87/6/642.short
4100  - http://jnnp.bmj.com/content/87/6/642.full
SO  - J Neurol Neurosurg Psychiatry2016 Jun 01; 87
AB  - Objective Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome.Methods 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3–6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection.Results The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ2 test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively.Interpretation The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.