Correlating resting state functional MRI connectivity by independent component analysis-based epileptogenic zones with intracranial EEG localized seizure onset zones and surgical outcomes in prospective pediatric intractable epilepsy study.

Brain Connect. 2017 Aug 07;:

Authors: Boerwinkle V, Mohanty D, Foldes S, Guffey D, Minard CG, Mirea L, Vedantam A, Raskin JS, Lam S, Bond M, Adelson PD, Wilfong AA, Curry DJ

Abstract
OBJECTIVE: Prospective investigation determining agreement between the epileptogenic zone(s) (EZ) localization by resting state functional MRI (rs-fMRI) and the seizure onset zone(s) (SOZ) identified by intracranial EEG (ic-EEG) using novel differentiating and ranking criteria of rs-fMRI abnormal independent components in a consecutive heterogeneous pediatric intractable epilepsy population prospectively was conducted.
METHODS: The EZ criteria were developed from an initial cohort of 350 patients evaluated for epilepsy surgery over a 3-year period. Subsequently, these criteria were applied prospectively to an evaluation cohort of 40 patients who underwent ic-EEG for SOZ identification. Thirty-seven of these patients had surgery and one year outcomes were collected.
RESULTS: Sensitivity of rs-fMRI EZ was 93% (95% CI 78% to 98%) with positive predictive value of surgical outcome was 79% (95% CI 63% to 89%). Agreement between rs-fMRI EZ and ic-EEG SOZ was 90% (36/40; 95% CI, 0.76-0.97). In those with cryptogenic localization-related epilepsy, agreement between rs-fMRI EZ and ic-EEG SOZ was 89% (8/9; 95% CI, 0.52-99). Without resection of rs-fMRI EZ, 75% continued to have seizures one year later. Conversely, 75% of patients in whom rs-fMRI agreed with ic-EEG SOZ and had no anatomically separate rs-fMRI EZ, only 24% continued to have seizures one year later (p =0.01).
CONCLUSION: Rs-fMRI EZ surgical destruction showed significant association with post-operative seizure outcome. The pediatric population with intractable epilepsy studied prospectively provides evidence for use of rs-fMRI ranking criteria, to identify rs-fMRI EZ, as developed by the lead author (VLB). This is a high yield test in this population. Thus rs-fMRI EZ detected by this technique are potentially informative for epilepsy surgery evaluation and planning in this population. Independent of other brain function testing modalities, contextual ranking of abnormal independent components of rs-fMRI localized EZs correlated with the gold standard of SOZ localization, ic-EEG, including cryptogenic epilepsy.

PMID: 28782373 [PubMed - as supplied by publisher]