title: The diagnostic utility of 3D-ESI rotating and moving dipole methodology in the pre-surgical evaluation of MRI-negative childhood epilepsy due to focal cortical dysplasia.
abstract: This study investigates whether a combined rotating dipole (RD) and moving dipole (MD) solution enhances three-dimensional electroencephalography (EEG) source imaging (3D-ESI) localization in magnetic resonance imaging (MRI)-negative pediatric patients with focal cortical dysplasia (FCD).
  
  
  
  We retrospectively selected 14 MRI-negative patients with FCD from a cohort of 60 pediatric patients previously used to evaluate the diagnostic utility of 3D-ESI in epilepsy surgery. Patients were younger than 18 years at time of surgery and had at least 1 year of outcome data. RD and MD models were constructed for each interictal spike or sharp wave, and it was determined whether each inverse algorithm localized within the surgical resection cavity (SRC). We also compared the 3D-ESI findings and surgical outcome with positron emission tomography (PET) and ictal single photon emission computed tomography (iSPECT).
  
  
  
  RD analyses revealed a high concordance with the SRC (78.6%), particularly for temporal lobe resection (100.0%), and showed superior localization compared to PET and iSPECT, with the highest correlation in FCD type I and temporal lobe resection. Furthermore, the RD method was superior to iSPECT in FCD type II cases and to PET in extratemporal resections. RD and MD results were comparable, but in 18.2% of patients with FCD type I with localizing RDs, the MD solution was only partially within the SRC; in all of these patients 3D-ESI also correlated with superior surgical outcome compared to PET and iSPECT, especially when RD and MD solutions were analyzed together.
  
  
  
  3D-ESI in MRI-negative cases showed superior localization compared to iSPECT or PET, especially in FCD type I and temporal lobe epilepsy, and correlated with superior surgical outcome compared to iSPECT and PET at 1 year and 2 years postoperatively, especially when RD and MD solutions were analyzed together. These findings suggest that 3D-ESI based on a combined RD-MD solution improves surgical accuracy in MRI-negative patients with FCD.
authors.affiliation: Child Neurology Unit, IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Matt
authors.initials: M
authors.lastname: Lallas
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Jayakar
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Ian
authors.initials: I
authors.lastname: Miller
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Ann
authors.initials: A
authors.lastname: Hyslop
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Catalina
authors.initials: C
authors.lastname: Dunoyer
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.|Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Trevor
authors.initials: T
authors.lastname: Resnick
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.|Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Michael
authors.initials: M
authors.lastname: Duchowny
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D065703:Malformations of Cortical Development, Group I / Q000150:complications*; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: Epilepsy surgery; Focal cortical dysplasia; MRI-negative; Source localization