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MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings.
Epilepsia. 2007 Jan; 48(1):149-57.E

Abstract

PURPOSE

To identify the predictors of postsurgical seizure freedom in children with refractory epilepsy and normal or nonfocal MRI findings.

METHODS

We analyzed 22 children with normal or subtle and nonfocal MRI findings, who underwent surgery for intractable epilepsy following extraoperative intracranial EEG. We compared clinical profiles, neurophysiological data (scalp EEG, magnetoencephalography (MEG) and intracranial EEG), completeness of surgical resection and pathology to postoperative seizure outcomes.

RESULTS

Seventeen children (77%) had a good postsurgical outcome (defined as Engel class IIIA or better), which included eight (36%) seizure-free children. All children with postsurgical seizure freedom had an MEG cluster in the final resection area. Postsurgical seizure freedom was obtained in none of the children who had bilateral MEG dipole clusters (3) or only scattered dipoles (1). All five children in whom ictal onset zones were confined to < or = 5 adjacent intracranial electrodes achieved seizure freedom compared to three of 17 children with ictal onset zones that extended over >5 electrodes (p = 0.002). None of six children with more than one type of seizure became seizure-free, compared to eight of 16 children with a single seizure type (p = 0.04). Complete resection of the preoperatively localized epileptogenic zone resulted in seizure remission in 63% (5/8) and incomplete resections, in 21% (3/14) (p = 0.06). Age of onset, duration of epilepsy, number of lobes involved in resection, and pathology failed to correlate with seizure freedom.

CONCLUSIONS

Surgery for intractable epilepsy in children with normal MRI findings provided good postsurgical outcomes in the majority of our patients. As well, restricted ictal onset zone predicted postoperative seizure freedom. Postoperative seizure freedom was less likely to occur in children with bilateral MEG dipole clusters or only scattered dipoles, multiple seizure types and incomplete resection of the proposed epileptogenic zone. Seizure freedom was most likely to occur when there was concordance between EEG and MEG localization and least likely to occur when these results were divergent.

Authors+Show Affiliations

Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. rajeshrnair@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17241222

Citation

RamachandranNair, Rajesh, et al. "MEG Predicts Outcome Following Surgery for Intractable Epilepsy in Children With Normal or Nonfocal MRI Findings." Epilepsia, vol. 48, no. 1, 2007, pp. 149-57.
RamachandranNair R, Otsubo H, Shroff MM, et al. MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings. Epilepsia. 2007;48(1):149-57.
RamachandranNair, R., Otsubo, H., Shroff, M. M., Ochi, A., Weiss, S. K., Rutka, J. T., & Snead, O. C. (2007). MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings. Epilepsia, 48(1), 149-57.
RamachandranNair R, et al. MEG Predicts Outcome Following Surgery for Intractable Epilepsy in Children With Normal or Nonfocal MRI Findings. Epilepsia. 2007;48(1):149-57. PubMed PMID: 17241222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings. AU - RamachandranNair,Rajesh, AU - Otsubo,Hiroshi, AU - Shroff,Manohar M, AU - Ochi,Ayako, AU - Weiss,Shelly K, AU - Rutka,James T, AU - Snead,O Carter,3rd PY - 2007/1/24/pubmed PY - 2007/3/28/medline PY - 2007/1/24/entrez SP - 149 EP - 57 JF - Epilepsia JO - Epilepsia VL - 48 IS - 1 N2 - PURPOSE: To identify the predictors of postsurgical seizure freedom in children with refractory epilepsy and normal or nonfocal MRI findings. METHODS: We analyzed 22 children with normal or subtle and nonfocal MRI findings, who underwent surgery for intractable epilepsy following extraoperative intracranial EEG. We compared clinical profiles, neurophysiological data (scalp EEG, magnetoencephalography (MEG) and intracranial EEG), completeness of surgical resection and pathology to postoperative seizure outcomes. RESULTS: Seventeen children (77%) had a good postsurgical outcome (defined as Engel class IIIA or better), which included eight (36%) seizure-free children. All children with postsurgical seizure freedom had an MEG cluster in the final resection area. Postsurgical seizure freedom was obtained in none of the children who had bilateral MEG dipole clusters (3) or only scattered dipoles (1). All five children in whom ictal onset zones were confined to < or = 5 adjacent intracranial electrodes achieved seizure freedom compared to three of 17 children with ictal onset zones that extended over >5 electrodes (p = 0.002). None of six children with more than one type of seizure became seizure-free, compared to eight of 16 children with a single seizure type (p = 0.04). Complete resection of the preoperatively localized epileptogenic zone resulted in seizure remission in 63% (5/8) and incomplete resections, in 21% (3/14) (p = 0.06). Age of onset, duration of epilepsy, number of lobes involved in resection, and pathology failed to correlate with seizure freedom. CONCLUSIONS: Surgery for intractable epilepsy in children with normal MRI findings provided good postsurgical outcomes in the majority of our patients. As well, restricted ictal onset zone predicted postoperative seizure freedom. Postoperative seizure freedom was less likely to occur in children with bilateral MEG dipole clusters or only scattered dipoles, multiple seizure types and incomplete resection of the proposed epileptogenic zone. Seizure freedom was most likely to occur when there was concordance between EEG and MEG localization and least likely to occur when these results were divergent. SN - 0013-9580 UR - https://www.unboundmedicine.com/medline/citation/17241222/MEG_predicts_outcome_following_surgery_for_intractable_epilepsy_in_children_with_normal_or_nonfocal_MRI_findings_ L2 - https://doi.org/10.1111/j.1528-1167.2006.00901.x DB - PRIME DP - Unbound Medicine ER -