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Brain Advance Access originally published online on July 22, 2003
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Brain, Vol. 126, No. 11, 2396-2405, November 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg239

Magnetic brain source imaging of focal epileptic activity: a synopsis of 455 cases

H. Stefan, C. Hummel, G. Scheler, A. Genow, K. Druschky, C. Tilz, M. Kaltenhäuser, R. Hopfengärtner, M. Buchfelder1 and J. Romstöck1

Department of Neurology, Epilepsy Center and 1 Department of Neurosurgery, University of Erlangen-Nuernberg, Erlangen, Germany

Correspondence to: Prof. Dr Hermann Stefan, Department of Neurology, University of Erlangen-Nuernberg, Schwabachanlage 6, D-91054 Erlangen, Germany E-mail: hermann.stefan{at}neuro.imed.uni-erlangen.de

Epilepsy surgery is based upon the minute assessment of brain tissue generating epileptic activity. A number of diagnostic methods are employed in the process of presurgical evaluation, supplying information on various morphological and functional aspects, ultimately integrated into the general result fundamental to the final treatment decision. Magnetic source imaging (MSI), combining structural (MRI) and functional (MEG) data, has been playing an increasingly important role among the tools of presurgical epilepsy evaluation. However, in spite of a considerable number of publications, the samples used have hardly exceeded 50 cases. Therefore, we present a synopsis of 455 epilepsy patients who underwent MSI investigations. Analysis of this substantial data revealed that the average sensitivity of MEG for specific epileptic activity was 70%. Among 131 patients who underwent surgical therapy in addition to antiepileptic drug medication, MSI identified the lobe to be treated in 89%, with results for extratemporal cases being even superior to those with temporal lobe surgery. Introducing a measure to quantify the contribution of MSI to the general result of presurgical evaluation that was applied to 104 patients, the results showed that MSI supplied additional information in 35% and information crucial to final decision making in 10%. Accuracy as well as contribution findings underlined MSI appropriateness even for extratemporal epilepsies, which otherwise frequently prove difficult with respect to focus localization.


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