Accuracy of Inter-Ictal High Density Electric Source Imaging in Adults and Children: Systematics Review and Meta-analysis
Abstract number :
V.031
Submission category :
3. Neurophysiology / 3G. Computational Analysis & Modeling of EEG
Year :
2021
Submission ID :
1826741
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Suhrad Pethani, BS, MS. PDiploma - Sydney Children’s Hospital, Randwick, NSW 2031, Australia; Daniel Flanagan - Department of Neurology - Sydney Children’s Hospital, Randwick, NSW 2031, Australia; Michael Cardamone - Department of Neurology - Sydney Children’s Hospital, Randwick, NSW 2031, Australia; Frederic Wegner - School of Medical Sciences - University of New South Wales, Kensington, NSW 2052, Australia; John Lawson - Department of Neurology - Sydney Children’s Hospital, Randwick, NSW 2031, Australia
Rationale: Electric source imaging (ESI) is a widely studied collection of methods which helps localise electrical discharges measured with surface electroencephalography (EEG) using a brain model. This method potentially provides valuable information in the pre-surgical evaluation of patients with pharmacoresistant epilepsy (Toscano et al., 2020). Advances in technology have made it easier to record surface EEG with a high-dense electrode channels and to obtain improved EEG localisation of the epileptogenic zone (Sharma et al., 2019). As a result, numerous studies have been conducted to validate the utility of this method, however, the method is still limited to complex epilepsy centres who often perform pre-surgical evaluation and mostly restricted to adults (Mégevand & Seeck, 2020). The study was aimed at reviewing published scholarly evidence on the diagnostic accuracy of inter-ictal high density ESI (HD-ESI) in epilepsy surgery.
Aims: To undertake a systematic review of the literature regarding the sensitivity, specificity and accuracy of interictal HD-ESI in presurgical evaluation of patients with pharmaco-resistant epilepsy.
Methods: Scientific databases were searched for publications reporting the use of HD-ESI ( 64 electrodes) and the research outcomes as well as the effect of site of resection to a lobar or sub-lobar level. Patient data was pooled from selected studies to calculate the diagnostic accuracy measures for HD-ESI on pooled patients and for adult and children subgroups. HD-ESI was considered true positive, when HD-ESI localisation was concordant with resection and resulted in Engel class I post-surgical outcome.
Results: Our primary literature search resulted in 534 studies. Nineteen studies fulfilled the selection criteria, providing data from 410 operated patients (113 paediatric patients, 164 adult patients and 133 patients with unspecified age). The sensitivity and specificity of HD-ESI were estimated to be 76% and 53.5%, respectively with overall accuracy of 71% based on concordance between focus of HD-ESI and site of resection and surgical outcome (seizure freedom classified as Engel class 1). Based on the same parameters for accuracy determination, sensitivity and specificity in adults and children were as follows: Adults: sensitivity-72.9%, specificity- 48.3%, Children: sensitivity-71.4%, specificity- 60.9%.
Conclusions: The literature suggests that the accuracy of interictal HD-ESI in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy is reasonable. The method has an appreciably high sensitivity (76%) and low-average specificity (~53%). Comparison of sensitivity and specificity of HD-ESI amongst children and adults showed significant differences in specificity (p=0.0135) between these groups with the procedure having higher specificity in children. Based on our data, HD-ESI should be incorporated as a part of multimodal pre-surgical evaluation in children with pharmaco-resistant epilepsy as it can add significant value.
Funding: Please list any funding that was received in support of this abstract.: Nil to disclose.
Neurophysiology