Brain Advance Access originally published online on September 12, 2007
Brain 2007 130(12):3169-3183; doi:10.1093/brain/awm218
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Stereoelectroencephalography in presurgical assessment of MRI-negative epilepsy
1INSERM, U 751, Laboratoire de Neurophysiologie et Neuropsychologie, Marseille, F-13000, 2Aix Marseille Université, Faculté de Médecine, Marseille, F-13000, 3Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, 4Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Service d’Anatomie Pathologique, Marseille, F-13005, 5Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Service de Neurochirurgie, Marseille, F-13005 and 6Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Service de Neuroradiologie, Marseille, F-13005, France
Correspondence to: Dr Aileen McGonigal, Laboratoire de Neurophysiologie et Neuropsychologie, INSERM U 751 & Service de Neurophysiologie Clinique, CHU Timone, Marseille, France, 27 boulevard Jean Moulin 13005 Marseille France E-mail: aileenmcg{at}hotmail.com
According to most existing literature, the absence of an MRI lesion is generally associated with poorer prognosis in resective epilepsy surgery. Delineation of the epileptogenic zone (EZ) by intracranial recording is usually required but is perceived to be more difficult in ‘MRI negative’ cases. Most previous studies have used subdural recording and there is relatively less published data on stereoelectroencephalography (SEEG). The objective of this study was to report the experience of our group in using SEEG in presurgical evaluation, comparing its effectiveness in normal and lesional MRI cases. One hundred consecutive patients undergoing SEEG for presurgical assessment were studied. Forty-three patients out of one hundred (43%) had normal MRI and 57 (57%) had lesional MRI. Successful localization was achieved with no difference between these two groups, in 41/43 (95%) normal MRI and in 55/57 (96%) lesional MRI cases (P = 1.00). Surgery was proposed in 84/100 patients and contraindicated in 16/100 with no significant difference between lesional and MRI-negative groups (P > 0.05). At 1 year follow-up, 11/20 (55%) of those having undergone cortectomy in the MRI-negative group and 21/40 (53%) in the lesional MRI group were entirely seizure free (P > 0.05) and these proportions were maintained at 2 years follow-up. Significant improvement in seizure control (ILAE outcome groups 1–4) was achieved in >90% cases with no difference between groups (P > 0.05). Of MRI-negative cases that underwent surgery, 10/23 (43%) had focal cortical dysplasia. This series showed that SEEG was equally effective in the presurgical evaluation of MRI-negative and lesional epilepsies.
Key Words: stereoelectroencephalography (SEEG); depth electrodes; intracranial EEG; epilepsy surgery
Abbreviations: OP, opercular frontal cortex; DLPF9/46, dorsolateral prefrontal cortex, Brodmann area 9/46; PSMA, preSMA; CG 24, cingulate cortex Brodmann 24; TP, temporal pole; STG, superior temporal gyrus; Am, amygdala; MTG, middle temporal gyrus
Received March 20, 2007. Revised July 29, 2007. Accepted August 20, 2007.
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