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Kishk NA, Shamloul R, Moawad MK, Hamdi H, Morsy AA, Baghdadi M, Rizkallah M, Nawito A, Mohammad ME, Magdy R, Alsayyad E, Othman AS, Fouad AM, Rizk H. Cost-effectiveness of HARNESS-MRI protocol in focal drug-resistant epilepsy in a limited-resources country: An Egyptian study. Clin Neurol Neurosurg 2023; 233:107946. [PMID: 37639829 DOI: 10.1016/j.clineuro.2023.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The international league against epilepsy (ILAE) recommended the harmonized neuroimaging of epilepsy structural sequences (HARNESS-MRI) to improve the detection of epileptogenic lesions in patients with focal drug-resistant epilepsy (DRE). The application of this protocol is still limited in low-resource countries, mainly due to apparent high costs. We aimed to evaluate the cost-effectiveness of the HARNESS-MRI protocol in Egypt and highlighted our experience. METHODS Patients diagnosed with focal DRE at Cairo University epilepsy clinic underwent both conventional MRI (c-MRI) and HARNESS-MRI. Electro-clinical data were collected and analyzed. After the radiologists' initial diagnosis, a multidisciplinary team re-evaluated the MRI. Lesion detection rate and cost for detecting an extra lesion by HARNESS-MRI protocol were calculated. RESULTS The study included 230 patients with focal DRE (146, 62% males and 91, 38% females), with a mean age of 20.5 years. Epileptogenic lesions detected by c-MRI and HARNESS-MRI before and after the board meeting were 40, 106, and 131 lesions, respectively (P < 0.001). Sixty-nine percent of the lesions detected by HARNESS-MRI were missed on c-MRI; most commonly were mesial temporal sclerosis (MTS) and Malformations of cortical development (MCDs). Thirty-seven MTS and 32 MCDs were detected with HARNESS-MRI, compared to only 6 and 3, respectively, detected on c-MRI (P < 0.001). HARNESS-MR protocol is more cost-effective than c-MRI in detecting MRI lesions; it can save about 42$ for detecting an extra lesion in MRI. CONCLUSION The HARNESS-MRI protocol was cost-effective and highly recommended even in limited-resource countries for patients with focal DRE.
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Affiliation(s)
- Nirmeen A Kishk
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | - Reham Shamloul
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | - Mona K Moawad
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | - Hussein Hamdi
- Neurosurgery Department, Faculty of Medicine, Tanta University, Egypt
| | - Ahmed A Morsy
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Egypt
| | | | | | - Amani Nawito
- Neurophysiology Department, Faculty of Medicine, Cairo University, Egypt
| | | | - Rehab Magdy
- Neurology Department, Faculty of Medicine, Cairo University, Egypt.
| | - Enas Alsayyad
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | | | - Amr M Fouad
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | - Haytham Rizk
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
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Vaudano AE, Ballerini A, Zucchini F, Micalizzi E, Scolastico S, Talami F, Giovannini G, Pugnaghi M, Orlandi N, Biagioli N, Cioclu MC, Vallone S, Genovese M, Todeschini A, Cavalleri F, Malagoli M, Meletti S. Impact of an optimized epilepsy surgery imaging protocol for focal epilepsy: a monocentric prospective study. Epileptic Disord 2023; 25:45-56. [PMID: 36946331 DOI: 10.1002/epd2.20050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/13/2023] [Revised: 02/12/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate in a real clinical scenario the impact of the ILAE-recommended "Harmonized neuroimaging of epilepsy structural sequences"- HARNESS protocol in patients affected by focal epilepsy. METHODS We prospectively enrolled focal epilepsy patients who underwent a structural brain MRI between 2020-2021 at Modena University Hospital. For all patients, MRIs were: a) acquired according to the HARNESS-MRI protocol (H-MRI); b) reviewed by the same neuroradiology team. MRI outcomes measures were: the number of positive (diagnostic) and negative MRI; the type of radiological diagnosis classified in: 1. Hippocampal Sclerosis; 2. Malformations of cortical development (MCD); 3. Vascular malformations; 4. Glial scars; 5. Low-grade epilepsy-associated tumours; 6. Dual pathology. For each patient we verified for previous MRI (without HARNESS protocol, noH-MRI) and the presence of clinical information in the MRI request form. Then the measured outcomes were reviewed and compared as appropriate. RESULTS A total of 131 patients with H-MRI were included in the study. 100 patients out from this cohort had at least one previous noH-MRI scan. Of those, 92/100 were acquired at the same Hospital than H-MRI and 71/92 on a 3T scanner. The HARNESS protocol revealed 81 (62%) positive and 50 (38%) negative MRI, and MCD was the most common diagnosis (60%). Among the entire pool of 100 noH-MRI, 36 resulted positive with a significant difference (p<.001) compared to H-MRI. Similar findings were observed when accounting for the expert radiologists (H-MRI= 57 positive; noH-MRI=33, p<.001) and the scanner field strength (H-MRI 43=positive, noH-MRI=23, p<.001), while clinical information were more present in H-MRI (p<.002). SIGNIFICANCE The adoption of a standardized and optimized MRI acquisition protocol together with adequate clinical information contribute to identify a higher number of potentially epileptogenic lesions (especially FCD) thus impacting concretely on the clinical management of patients with focal epilepsy.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Elisa Micalizzi
- Neurophysiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Scolastico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Biagioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Cristina Cioclu
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | - Stefano Vallone
- Neuroradiology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | | | | | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
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Larivière S, Federico P, Chinvarun Y, Jackson G, Morgan V, Rampp S, Vaudano AE, Wang I, Cendes F, Boelman CG, Bernasconi A, Bernasconi N, Bernhardt BC, Schrader DV. ILAE Neuroimaging Task Force Highlight: harnessing optimized imaging protocols for drug-resistant childhood epilepsy. Epileptic Disord 2021; 23:675-81. [PMID: 34526291 DOI: 10.1684/epd.2021.1312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ILAE Neuroimaging Task Force aims to publish educational case reports highlighting basic aspects related to neuroimaging in epilepsy consistent with the educational mission of the ILAE. Previous quantitative MRI studies have established important imaging markers of epilepsy-related pathology, including features sensitive to hippocampal cell loss and reactive astrogliosis. Here, we review the case of a female with pediatric drug-resistant epilepsy. Throughout her course of treatment, she had seven MRI investigations at several centers; the first three did not follow optimized epilepsy imaging protocols whereas the remaining four adhered to HARNESS-MRI protocols ( har monized n euroimaging of e pilepsy s tructural s equences). Visual inspection of a set of HARNESS-MR images revealed conspicuous left hippocampal hyperintensity which may have been initially overlooked on non-optimized MR images. Quantitative analysis of these multimodal imaging data along hippocampal subfields provided clear evidence of hippocampal sclerosis, with increased atrophy, increased mean diffusivity, increased T2-FLAIR signal, and lower qT1 values observed in the anterior portions of the left, compared to the right hippocampus. The patient underwent a left anterior temporal lobectomy with amygdalohippocampectomy at age 16 years. Histopathology of the resected specimen also confirmed hippocampal sclerosis with widespread gliosis and focal neuronal loss in the hippocampal subfields overlapping with regions of multimodal quantitative alterations. The patient remains seizure-free one year after surgery. Collectively, this case highlights the need for optimized data acquisition protocols early in the treatment of epilepsy and supports quantitative analysis of MRI contrasts to enhance personalized diagnosis and prognosis of drug-resistant patients with epilepsy.
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