EEG Source Imaging in Pediatric Epilepsy Surgery: A New Perspective in Presurgical Workup
Authors: Sperli, Francesca1; Spinelli, Laurent; Seeck, Margitta2; Kurian, Mary2; Michel, Christoph M.3; Lantz, Göran3
Source: Epilepsia, Volume 47, Number 6, June 2006 , pp. 981-990(10)
Publisher: Blackwell Publishing
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Abstract:
Summary: Purpose: Epilepsy is a relatively frequent disease in children, with considerable impact on cognitive and social life. Successful epilepsy surgery depends on unambiguous focus identification and requires a comprehensive presurgical workup, including several neuroimaging techniques [magnetic resonance imaging, positron emission tomography (PET), and single-photon emission computed tomography (SPECT)]. These may be difficult to apply in younger or developmentally delayed children or both, requiring sedation, and hence, a significant workforce. Modern electric source imaging (ESI) provides accurate epileptic source-localization information in most patients, with minimal patient discomfort or need for cooperation. The purpose of the present study was to determine the usefulness of ESI in pediatric EEG recordings performed with routine electrode arrays. Methods: Preoperative EEGs recorded from 19 to 29 scalp electrodes were reviewed, and interictal epileptiform activity was analyzed by using a linear source-imaging procedure (depth-weighted minimum norm) in combination with statistical parametric mapping. Results: In 27 (90%) of 30 patients, the ESI correctly localized the epileptogenic region. These numbers compare favorably with the results from other imaging techniques in the same patients (PET, 82%; ictal SPECT, 70%). In extratemporal epilepsy, ESI was correct in all cases, and in temporal lobe epilepsy, in 10 of 13 cases. In two temporal lobe patients showing less-accurate ESI results, 128-electrode data could be analyzed, and in both cases, the 128-electrode ESI was correct. Conclusions: ESI with standard clinical EEG recordings provides excellent localizing information in pediatric patients, in particular in extratemporal lobe epilepsy. The lower yield in temporal lobe epilepsy seems to be due to undersampling of basal temporal areas with routine scalp recordings.Keywords: Epilepsy; Pediatric; EEG; Source imaging
Document Type: Research article
DOI: 10.1111/j.1528-1167.2006.00550.x
Affiliations: 1: University of Rome Tor Vergata, Rome, Italy 2: Unit of Presurgical Epilepsy Evaluation, Neurology Clinic, University Hospital, Geneva, Switzerland 3: Functional Brain Mapping Laboratory, Neurology Clinic
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