Synthetic aperture magnetometry and excess kurtosis mapping of Magnetoencephalography (MEG) is predictive of epilepsy surgical outcome in a large pediatric cohort
Synthetic aperture magnetometry and excess kurtosis mapping of Magnetoencephalography (MEG) is predictive of epilepsy surgical outcome in a large pediatric cohort
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DOI：
10.1016/j.eplepsyres.2019.106151
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发表时间：
2019-09-01
影响因子：
2.2
通讯作者：
Marsh, E. D.
中科院分区：
文献类型：
--
作者：
Gofshteyn, J. S.;Lee, T.;Marsh, E. D.
目的：切除手术是治疗难治性癫痫最有效的方法；然而，确定哪些患者将从癫痫手术中受益仍然具有挑战性。脑磁图（MEG）的合成孔径磁强计和过量峰度图（SAM(g2)）是一种非侵入性工具，值得在儿童癫痫人群中进一步检查。在这里，我们检查了MEG与SAM的效用（g2），以确定癫痫样MEG灶是否与手术结果相关，并建立了一个结合MEG信息的预测模型，以最好地评估癫痫发作改善/从切除手术中解脱的可能性。方法：筛选2010-2015年在费城儿童医院行MEG的564例受试者。提取临床癫痫病史和既往电图记录，并与MEG结果进行对照。脑磁图评估由神经学家和神经放射学家共同完成。建立预测模型，评估脑磁图在切除性癫痫手术后1年和5年确定Engel分级的效用。结果：1年和5年的Engel分级结果与脑磁图峰值的数量高度相关；然而，单独使用MEG数据并不能显著预测5年的手术结果。结合临床因素；在logistic回归模型中，头皮EEG（单起病区）、MRI（有无病变）、年龄和性别对1年（p = 0.03）和5年（p = 0.02）的Engel分级结果均有显著性影响。Engel类1年的正确率为78.43%，阳性预测值为71.43。意义：MEG使用SAM（g2）分析是一种重要的非侵入性工具，可以识别哪些患者将从手术中获益最多。将脑磁图数据分析纳入术前评估有助于预测小儿切除手术后癫痫的预后，如果使用熟练的解释。
Objective: Resective surgery is the most effective treatment option for patients with refractory epilepsy; however identification of patients who will benefit from epilepsy surgery remains challenging. Synthetic aperture magnetometry and excess kurtosis mapping (SAM(g2)) of magnetoencephalography (MEG) is a non-invasive tool that warrants further examination in the pediatric epilepsy population. Here, we examined the utility of MEG with SAM(g2) to determine if MEG epileptiform foci correlates with surgical outcome and to develop a predictive model incorporating MEG information to best assess likelihood of seizure improvement/freedom from resective surgery.Methods: 564 subjects who had MEG at the Children's Hospital of Philadelphia between 2010-2015 were screened. Clinical epilepsy history and prior electrographic records were extracted and reviewed and correlated with MEG findings. MEG assessments were made by both a neurologist and neuroradiologist. Predictive models were developed to assess the utility of MEG in determining Engel class at one year and five years after resective epilepsy surgery.Results: The number of MEG spike foci was highly associated with Engel class outcome at both one year and five years; however, using MEG data in isolation was not significantly predictive of 5 year surgical outcome. When combined with clinical factors; scalp EEG (single ictal onset zone), MRI (lesional or not), age and sex in a logistic regression model MEG foci was significant for Engel class outcome at both 1 year (p = 0.03) and 5 years (0.02). The percent correctly classified for Engel class at one year was 78.43% and the positive predictive value was 71.43.Significance: MEG using SAM(g2) analysis in an important non-invasive tool in the identification of those patients who will benefit most from surgery. Integrating MEG data analysis into pre-surgical evaluation can help to predict epilepsy outcome after resective surgery in the pediatric population if utilized with skilled interpretation.