Zgodność wyników magnetoencefalografii i głębokich elektrod mózgowych oraz ich związek z wynikami operacji u pacjentów z epilepsją bez zmian w rezonansie magnetycznym
Concordance between magnetoencephalography and intracranial EEG and association with surgical outcomes in MRI-negative epilepsy
W skrócie
Badanie dotyczy 51 pacjentów z opornymi na leki napadami padaczki, u których nie widać zmian w rezonansie magnetycznym mózgu. Naukowcy sprawdzali, jak dobrze wyniki specjalnych badań mózgu (magnetoencefalografia) zgadzają się z bardziej dokładnym badaniem za pomocą elektrod wszczepowych, a także czy ta zgodność wpływa na powodzenie operacji. Okazało się, że u pacjentów, u których wyniki badań się zgadzały, operacja przyniosła dobre rezultaty - aż 91-100 procent chorych przestało mieć napady lub ich znacznie się zmniejszyło.
Oryginalny abstract (angielski)
PURPOSE: Magnetoencephalography (MEG) is increasingly used in the presurgical evaluation of drug-resistant epilepsy (DRE), particularly in MRI-negative cases. However, the relationship between MEG localization, intracranial EEG (iEEG) concordance, underlying pathology, and surgical outcomes remains incompletely defined. METHODS: We performed a retrospective cohort study of 51 patients with MRI-negative DRE who underwent MEG and iEEG evaluation at our center from 2009 to 2025. MEG spike source localization was categorized as complete, partial, or discordant relative to the iEEG-defined SOZ using a lobar-level concordance framework. Surgical outcomes were assessed in 29 patients who underwent resective surgery using the Engel classification at 6 months, 1 year, 2 years, and last follow-up. Associations between concordance, pathology, and outcomes were evaluated using chi-square or Fisher's exact tests as appropriate, with Monte-Carlo exact inference used for sparse contingency tables. RESULTS: MEG identified localizing interictal abnormalities in 33 of 51 patients (65%), while 18 (35%) had no MEG spikes. Among 32 patients with both localizing MEG and an iEEG-defined SOZ, complete lobar-level concordance was observed in 23 (72%), partial concordance in 7 (22%), and discordance in 2 (6%). At 1 year after resection, Engel class I outcomes were observed in 10 of 11 patients (91%) with complete concordance, 5 of 5 (100%) with partial concordance, and 5 of 8 patients (63%) with MEG-negative studies. Exploratory Monte-Carlo exact analysis demonstrated a significant impact of histopathology on the distribution of MEG-iEEG concordance (p = 0.004). Histopathology was not a significant predictor of study MEG positivity. CONCLUSIONS: MEG identified localizing interictal abnormalities in approximately two-thirds of this selected cohort of patients with MRI-negative DRE. When MEG was localizing and an iEEG-defined SOZ was identified, lobar-level concordance was common. Because MEG could inform invasive evaluation, these findings reflect concordance within an MEG-informed clinical workflow rather than independent validation against iEEG. Surgical outcome and histopathology associations were exploratory and will need to be validated in larger cohorts.