title: Three-dimensional intracranial EEG monitoring in presurgical assessment of MRI-negative frontal lobe epilepsy.
abstract: Magnetic resonance imaging (MRI)-negative epilepsy is associated with poor clinical outcomes prognosis. The present study was aimed to assess whether intracranial 3D interictal and ictal electroencephalography (EEG) findings, a combination of EEG at a different depth, in addition to clinical, scalp EEG, and positron emission tomography-computed tomography (PETCT) data help to predict outcome in a series of patients with MRI-negative frontal lobe epilepsy (FLE) after surgery.Patients with MRI-negative FLE who were presurgically evaluated by 3D-intracranial EEG (3D-iEEG) recording were included. Outcome predictors were compared in patients with seizure freedom (group 1) and those with recurrent seizures (group 2) at least 24 months after surgery.Forty-seven patients (15 female) were included in this study. MRI was found normal in 38 patients, whereas a focal or regional hypometabolism was observed in 33 cases. Twenty-three patients (48.9%) were seizure-free (Engel class I), and 24 patients (51.1%) continued to have seizures (12 were class II, 7 were class III, and 5 were class IV). Detailed analysis of intracranial EEG revealed widespread (>2 cm) (17.4%:75%; P = 0.01) in contrast to focal seizure onset as well as shorter latency to onset of seizure spread (5.9 ± 7.1 s; 1.4 ± 2.9 s; P = 0.016) and to ictal involvement of brain structures beyond the frontal lobe (21.8 ± 20.3 s; 4.9 ± 5.1 s; P = 0.025) in patients without seizure freedom.The results suggest that presurgical evaluation using 3D-iEEG monitoring lead to a better surgical outcome as seizure free in MRI-negative FLE patients.
authors.affiliation: Department of Neurosurgery Departmnt of Epileptology Department of Medical Imaging Department of Pathology, Fuzhou General Hospital , Xiamen University Medical College, Fuzhou, China.
authors.forename: Peng-Fan
authors.initials: PF
authors.lastname: Yang
authors.forename: Ming-Chao
authors.initials: MC
authors.lastname: Shang
authors.forename: Qiao
authors.initials: Q
authors.lastname: Lin
authors.forename: Hui
authors.initials: H
authors.lastname: Xiao
authors.forename: Zhen
authors.initials: Z
authors.lastname: Mei
authors.forename: Yan-Zeng
authors.initials: YZ
authors.lastname: Jia
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Zhong-Hui
authors.initials: ZH
authors.lastname: Zhong
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods*; D017034:Epilepsy, Frontal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18