Background: Temporal lobe epilepsy (TLE) is a complex neuropsychiatric illness that alters patient's behavior and social well-being. Early and accurate diagnosis of TLE is a key factor in its treatment. Currently, magnetic resonance spectroscopy (MRS) is recommended due to its high sensitivity and specificity in the detection of seizures. However, some studies have reported on its limited role in lesion detection.
Objectives: The present meta-analysis aims to analyze different studies thoroughly and investigate the role of MRS in the detection of TLE.
Material and methods: A systematic literature review was conducted using Medline (via PubMed), Cinahl (via EBSCO), Scopus, and Web of Sciences databases for case-control, retrospective and prospective studies regarding the use of MRS in detecting TLE. Studies were included using the Population, Intervention, Comparison, Outcomes and Study (PICOS) criteria and relevant event data were extracted. The risk of publication bias was analyzed using the Begg and Mazumdar test. A risk of bias assessment was conducted using RevMan software. The Mantel-Haenszel method was used to calculate the sensitivity, pooled odds ratio (OR), and risk ratio (RR), also using RevMan software.
Results: A total of 16 studies published between 2000 and 2022 were included, which encompassed a total of 645 patients. We obtained a high sensitivity of 84.8%, which shows a high efficiency of MRS, and a pooled OR value of 0.37 (95% confidence interval (95% CI): 0.14-0.97) with a tau2 value of 2.63, χ2 value of 84.99, degrees of freedom (df) value of 15, I2 value of 82%, Z-value of 2.03, and p < 0.05. The pooled RR was 0.82 (95% CI: 0.69-0.97) with a tau2 value of 0.10, χ2 value of 122.11, df of 15, I2 value of 88%, Z-value of 2.25, and p < 0.05. These results were statistically significant for a low risk of publication bias.
Conclusion: The current meta-analysis highly recommends the use of MRS in the accurate detection of alterations seen in the brain in patients with TLE.
Keywords: electroencephalography (EEG); magnetic resonance imaging (MRI); magnetic resonance spectroscopy (MRS); temporal lobe epilepsy (TLE).