Clinical added value of interictal automated electrical source imaging in the presurgical evaluation of MRI-negative epilepsy: A real-life experience in 29 consecutive patients

• Published in: Epilepsy & behavior 2023-06, Vol.143, p.109229-109229, Article 109229
• Main Authors: Santalucia, Roberto, Carapancea, Evelina, Vespa, Simone, Germany Morrison, Enrique, Ghasemi Baroumand, Amir, Vrielynck, Pascal, Fierain, Alexane, Joris, Vincent, Raftopoulos, Christian, Duprez, Thierry, Ferrao Santos, Susana, van Mierlo, Pieter, El Tahry, Riëm
• Format: Article
• Language: English
• Subjects: Automated ESI; Drug Resistant Epilepsy - diagnostic imaging; Drug Resistant Epilepsy - surgery; Electrocorticography; Electroencephalography - methods; Epilepsy - diagnostic imaging; Epilepsy - surgery; Humans; Magnetic Resonance Imaging - methods; MRI-negative epilepsy; Presurgical evaluation; Prospective Studies
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109229

•Electrical source imaging (ESI) performed by experts provides clinically useful information in about one-third of patients during the presurgical evaluation.•Manual ESI is time-consuming and requires specific expertise limiting its diffusion in clinical practice.•To promote ESI widespread use, fully and semi-automated analyses have been recently developed and validated.•In our study, automated interictal ESI led to a change in clinical management in 41% of patients with MRI-negative epilepsy undergoing presurgical work-up.•These changes proved to be clinically significant in 75% and 80% of those patients receiving SEEG or surgery, respectively. During the presurgical evaluation, manual electrical source imaging (ESI) provides clinically useful information in one-third of the patients but it is time-consuming and requires specific expertise. This prospective study aims to assess the clinical added value of a fully automated ESI analysis in a cohort of patients with MRI-negative epilepsy and describe its diagnostic performance, by evaluating sublobar concordance with stereo-electroencephalography (SEEG) results and surgical resection and outcome. All consecutive patients referred to the Center for Refractory Epilepsy (CRE) of St-Luc University Hospital (Brussels, Belgium) for presurgical evaluation between 15/01/2019 and 31/12/2020 meeting the inclusion criteria, were recruited to the study. Interictal ESI was realized on low-density long-term EEG monitoring (LD-ESI) and, whenever available, high-density EEG (HD-ESI), using a fully automated analysis (Epilog PreOp, Epilog NV, Ghent, Belgium). The multidisciplinary team (MDT) was asked to formulate hypotheses about the epileptogenic zone (EZ) location at sublobar level and make a decision on further management for each patient at two distinct moments: i) blinded to ESI and ii) after the presentation and clinical interpretation of ESI. Results leading to a change in clinical management were considered contributive. Patients were followed up to assess whether these changes lead to concordant results on stereo-EEG (SEEG) or successful epilepsy surgery. Data from all included 29 patients were analyzed. ESI led to a change in the management plan in 12/29 patients (41%). In 9/12 (75%), modifications were related to a change in the plan of the invasive recording. In 8/9 patients, invasive recording was performed. In 6/8 (75%), the intracranial EEG recording confirmed the localization of the ESI at a sublobar level.