Erschienen in:
13.06.2016 | Original Communication
Re-review of MRI with post-processing in nonlesional patients in whom epilepsy surgery has failed
verfasst von:
Z. Irene Wang, P. Suwanpakdee, S. E. Jones, Z. Jaisani, Ahsan N. V. Moosa, I. M. Najm, F. von Podewils, R. C. Burgess, B. Krishnan, R. A. Prayson, J. A. Gonzalez-Martinez, W. Bingaman, A. V. Alexopoulos
Erschienen in:
Journal of Neurology
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Ausgabe 9/2016
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Abstract
Management of MRI-negative patients with intractable focal epilepsy after failed surgery is particularly challenging. In this study, we aim to investigate whether MRI post-processing could identify relevant targets for the re-evaluation of MRI-negative patients who failed the initial resective surgery. We examined a consecutive series of 56 MRI-negative patients who underwent resective surgery and had recurring seizures at 1-year follow-up. T1-weighted volumetric sequence from the pre-surgical MRI was used for voxel-based MRI post-processing which was implemented in a morphometric analysis program (MAP). MAP was positive in 15 of the 56 patients included in this study. In 5 patients, the MAP+ regions were fully resected. In 10 patients, the MAP+ regions were not or partially resected: two out of the 10 patients had a second surgery including the unresected MAP+ region, and both became seizure-free; the remaining 8 patients did not undergo further surgery, but the unresected MAP+ regions were concordant with more than one noninvasive modality in 7. In the 8 patients who had unresected MAP+ regions and intracranial-EEG before the previous surgery, the unresected MAP+ regions were concordant with ictal onset in 6. Our data suggest that scrutiny of the presurgical MRI guided by MRI post-processing may reveal relevant targets for reoperation in nonlesional epilepsies. MAP findings, when concordant with the patient’s other noninvasive data, should be considered when planning invasive evaluation/reoperation for this most challenging group of patients.