Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia

Rupesh Kumar Chikara; Saeed Jahromi; Eleonora Tamilia; Joseph R Madsen; Steve M Stufflebeam; Phillip L Pearl; Christos Papadelis

doi:10.1016/j.clinph.2023.06.015

Electromagnetic source imaging predicts surgical outcome in children with focal cortical dysplasia

Clin Neurophysiol. 2023 Sep:153:88-101. doi: 10.1016/j.clinph.2023.06.015. Epub 2023 Jul 5.

Authors

Rupesh Kumar Chikara¹, Saeed Jahromi¹, Eleonora Tamilia², Joseph R Madsen³, Steve M Stufflebeam⁴, Phillip L Pearl⁵, Christos Papadelis⁶

Affiliations

¹ Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA.
² Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Jane and John Justin Institute for Mind Health, Neuroscience Research, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University, Fort Worth, TX, USA. Electronic address: christos.papadelis@cookchildrens.org.

PMID: 37473485
PMCID: PMC10528204 (available on 2024-09-01)
DOI: 10.1016/j.clinph.2023.06.015

Abstract

Objective: To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD).

Methods: We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (D_SOZ) and resection (D_RES). We estimated receiver operating characteristic (ROC) curves with Youden's index (J) to predict outcome.

Results: EMSI presented shorter D_SOZ (15.18 ± 9.06 mm) and D_RES (8.56 ± 6.24 mm) compared to ESI (D_SOZ: 25.04 ± 16.20 mm, p < 0.009; D_RES: 18.88 ± 17.30 mm, p < 0.03) and MSI (D_SOZ: 23.37 ± 8.98 mm, p < 0.03; D_RES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter D_SOZ and D_RES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering.

Conclusions: EMSI provides superior localization and improved predictive performance than individual modalities.

Significance: EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.

Keywords: Electromagnetic source imaging; Epilepsy surgery; Focal cortical dysplasia; Intracranial EEG; Irritative zone; Seizure onset zone.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Child
Drug Resistant Epilepsy* / complications
Drug Resistant Epilepsy* / diagnostic imaging
Drug Resistant Epilepsy* / surgery
Electroencephalography
Electromagnetic Phenomena
Epilepsy* / diagnosis
Focal Cortical Dysplasia*
Humans
Magnetic Resonance Imaging
Magnetoencephalography / methods
Retrospective Studies
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding