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Markoula S, Chaudhary UJ, Perani S, De Ciantis A, Yadee T, Duncan JS, Diehl B, McEvoy AW, Lemieux L. The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process: A prospective study. Seizure 2018; 61:30-37. [PMID: 30059825 DOI: 10.1016/j.seizure.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/27/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We set out to establish the clinical utility of EEG-correlated fMRI as part of the presurgical evaluation, by measuring prospectively its effects on the clinical decision. METHODS Patients with refractory extra-temporal focal epilepsy, referred for presurgical evaluation were recruited in a period of 18 months. The EEG-fMRI based localization was presented during a multi-disciplinary meeting after the team had defined the presumed RESULTS: Sixteen patients (six women), with a median age of 28 years, were recruited. Interpretable EEG-fMRI results were available in 13: interictal epileptic discharges (IEDs) were recorded in eleven patients and seizures were recorded in two patients. In three patients, no epileptic activity was captured during EEG-fMRI acquisition and in two of those an IED topographic map correlation was performed (between EEG recorded inside the scanner and long-term video EEG monitoring). EEG-fMRI results presentation had no impact on the initial clinical decision in three patients (23%) of the thirteen and resulted in a modification of the initial surgical plan in ten patients (77%) of the thirteen finally presented in MDT; in eight patients the impact was on the planned placement of invasive electrodes and in two patients the EEG-fMRI led to additional non-invasive tests before proceeding further with surgery. CONCLUSION The study is a prospective observational cohort study specifically designed to assess the impact of EEG-fMRI on the clinical decision making process, suggesting a significant influence of EEG-fMRI on epilepsy surgery planning.
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Affiliation(s)
- Sofia Markoula
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Neurology Department, University Hospital of Ioannina, Ioannina, Greece.
| | - Umair J Chaudhary
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK; Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Suejen Perani
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Alessio De Ciantis
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Tinonkorn Yadee
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; MRI Unit, Epilepsy Society, Chalfont St. Peter, Buckinghamshire, UK
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Coan AC, Chaudhary UJ, Grouiller F, Campos BM, Perani S, De Ciantis A, Vulliemoz S, Diehl B, Beltramini GC, Carmichael DW, Thornton RC, Covolan RJ, Cendes F, Lemieux L. EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2016. [PMID: 26216941 DOI: 10.1136/jnnp-2015-310401] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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%) (χ(2) 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.
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Affiliation(s)
- Ana C Coan
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
| | - Umair J Chaudhary
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Frédéric Grouiller
- Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Brunno M Campos
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
| | - Suejen Perani
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Alessio De Ciantis
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Serge Vulliemoz
- EEG and Epilepsy Unit and Functional Brain Mapping Laboratory, Neurology Department, University Hospitals and Faculty of Medicine of University of Geneva, Geneva, Switzerland
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Guilherme C Beltramini
- Neurophysics Group, Gleb Wataghin Physics Institute, University of Campinas, Campinas, Brazil
| | - David W Carmichael
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Rachel C Thornton
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Roberto J Covolan
- Neurophysics Group, Gleb Wataghin Physics Institute, University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
| | - Louis Lemieux
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
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Tiberi G, Costagli M, Biagi L, Ciantis AD, Fontana N, Stara R, Symms MR, Cosottini M, Guerrini R, Tosetti M. SAR prediction in adults and children by combining measured B1+ maps and simulations at 7.0 Tesla. J Magn Reson Imaging 2016; 44:1048-55. [DOI: 10.1002/jmri.25241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/01/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gianluigi Tiberi
- Imago7 Foundation; Pisa Italy
- Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance; IRCCS Stella Maris Foundation; Pisa Italy
| | - Mauro Costagli
- Imago7 Foundation; Pisa Italy
- Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance; IRCCS Stella Maris Foundation; Pisa Italy
| | - Laura Biagi
- Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance; IRCCS Stella Maris Foundation; Pisa Italy
| | | | - Nunzia Fontana
- Department of Information Engineering; University of Pisa; Pisa Italy
- National Institute of Nuclear Physics (INFN); Pisa Italy
| | - Riccardo Stara
- National Institute of Nuclear Physics (INFN); Pisa Italy
| | | | - Mirco Cosottini
- Department of Translational Research and New Surgical and Medical Technologies; University of Pisa; Pisa Italy
| | | | - Michela Tosetti
- Imago7 Foundation; Pisa Italy
- Laboratory of Medical Physics and Biotechnologies for Magnetic Resonance; IRCCS Stella Maris Foundation; Pisa Italy
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De Ciantis A, Barba C, Tassi L, Cosottini M, Tosetti M, Costagli M, Bramerio M, Bartolini E, Biagi L, Cossu M, Pelliccia V, Symms MR, Guerrini R. 7T MRI in focal epilepsy with unrevealing conventional field strength imaging. Epilepsia 2016; 57:445-54. [PMID: 26778405 DOI: 10.1111/epi.13313] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the diagnostic yield of 7T magnetic resonance imaging (MRI) in detecting and characterizing structural lesions in patients with intractable focal epilepsy and unrevealing conventional (1.5 or 3T) MRI. METHODS We conducted an observational clinical imaging study on 21 patients (17 adults and 4 children) with intractable focal epilepsy, exhibiting clinical and electroencephalographic features consistent with a single seizure-onset zone (SOZ) and unrevealing conventional MRI. Patients were enrolled at two tertiary epilepsy surgery centers and imaged at 7T, including whole brain (three-dimensional [3D] T1 -weighted [T1W] fast-spoiled gradient echo (FSPGR), 3D susceptibility-weighted angiography [SWAN], 3D fluid-attenuated inversion recovery [FLAIR]) and targeted imaging (2D T2*-weighted dual-echo gradient-recalled echo [GRE] and 2D gray-white matter tissue border enhancement [TBE] fast spin echo inversion recovery [FSE-IR]). MRI studies at 1.5 or 3T deemed unrevealing at the referral center were reviewed by three experts in epilepsy imaging. Reviewers were provided information regarding the suspected localization of the SOZ. The same team subsequently reviewed 7T images. Agreement in imaging interpretation was reached through consensus-based discussions based on visual identification of structural abnormalities and their likely correlation with clinical and electrographic data. RESULTS 7T MRI revealed structural lesions in 6 (29%) of 21 patients. The diagnostic gain in detection was obtained using GRE and FLAIR images. Four of the six patients with abnormal 7T underwent epilepsy surgery. Histopathology revealed focal cortical dysplasia (FCD) in all. In the remaining 15 patients (71%), 7T MRI remained unrevealing; 4 of the patients underwent epilepsy surgery and histopathologic evaluation revealed gliosis. SIGNIFICANCE 7T MRI improves detection of epileptogenic FCD that is not visible at conventional field strengths. A dedicated protocol including whole brain FLAIR and GRE images at 7T targeted at the suspected SOZ increases the diagnostic yield.
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Affiliation(s)
- Alessio De Ciantis
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carmen Barba
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Michela Tosetti
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Mauro Costagli
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | | | - Emanuele Bartolini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Laura Biagi
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Mark R Symms
- General Electric MR Scientist, Imago7, Pisa, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
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