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  Magnetoencephalography for epileptic focus localization in a series of 1000 cases

Rampp, S., Stefan, H., Wu, X., Kaltenhäuser, M., Maess, B., Schmitt, F. C., et al. (2019). Magnetoencephalography for epileptic focus localization in a series of 1000 cases. Brain, 142(10), 3059-3071. doi:10.1093/brain/awz231.

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Rampp, Stefan1, 2, Author
Stefan, Hermann3, Author
Wu, Xitong1, 4, Author
Kaltenhäuser, Martin1, Author
Maess, Burkhard5, Author              
Schmitt, Friedhelm C.6, Author
Wolters, Carsten H.7, Author
Hamer , Hajo8, Author
Kasper, Burkhard S.8, Author
Schwab, Stefan3, Author
Doerfler, Arndt9, Author
Blümcke, Ingmar10, Author
Rössler, Karl1, Author
Buchfelder, Michael1, Author
1Department of Neurosurgery, University Clinic Erlangen, Germany, ou_persistent22              
2Department of Neurosurgery, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany, ou_persistent22              
3Department of Neurology, University Clinic Erlangen, Germany, ou_persistent22              
4Department of Neurology, West China Hospital, Sichuan University, Chengdu, China, ou_persistent22              
5Methods and Development Unit - MEG and Cortical Networks, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_2205650              
6Department of Neurology, Otto von Guericke University Magdeburg, Germany, ou_persistent22              
7Institute for Biomagnetism and Biosignal Analysis, Münster University, Germany, ou_persistent22              
8Epilepsy Centre, University Clinic Erlangen, Germany, ou_persistent22              
9Department of Neuroradiology, University Clinic Erlangen, Germany, ou_persistent22              
10Department of Neuropathology, University Clinic Erlangen, Germany, ou_persistent22              


Free keywords: Epilepsy; Epilepsy surgery; Magnetoencephalography; Long-term outcome; Magnetic source imaging
 Abstract: The aim of epilepsy surgery in patients with focal, pharmacoresistant epilepsies is to remove the complete epileptogenic zone to achieve long-term seizure freedom. In addition to a spectrum of diagnostic methods, magnetoencephalography focus localization is used for planning of epilepsy surgery. We present results from a retrospective observational cohort study of 1000 patients, evaluated using magnetoencephalography at the University Hospital Erlangen over the time span of 28 years. One thousand consecutive cases were included in the study, evaluated at the university Hospital Erlangen between 1990 and 2018. All patients underwent magnetoencephalography as part of clinical workup for epilepsy surgery. Of these, 405 underwent epilepsy surgery after magnetoencephalography, with postsurgical follow-ups of up to 20 years. Sensitivity for interictal epileptic activity was evaluated, in addition to concordance of localization with the consensus of presurgical workup on a lobar level. We evaluate magnetoencephalography characteristics of patients who underwent epilepsy surgery versus patients who did not proceed to surgery. In operated patients, resection of magnetoencephalography localizations were related to postsurgical seizure outcomes, including long-term results after several years. In comparison, association of lesionectomy with seizure outcomes was analysed. Measures of diagnostic accuracy were calculated for magnetoencephalography resection and lesionectomy. Sensitivity for interictal epileptic activity was 72% with significant differences between temporal and extra-temporal lobe epilepsy. Magnetoencephalography was concordant with the presurgical consensus in 51% and showed additional or more focal involvement in an additional 32%. Patients who proceeded to surgery showed a significantly higher percentage of monofocal magnetoencephalography results. Complete magnetoencephalography resection was associated with significantly higher chances to achieve seizure freedom in the short and long-term. Diagnostic accuracy was significant in temporal and extra-temporal lobe cases, but was significantly higher in extra-temporal lobe epilepsy (diagnostic odds ratios of 4.4 and 41.6). Odds ratios were also higher in non-lesional versus lesional cases (42.0 versus 6.2). The results show that magnetoencephalography provides non-redundant information, which significantly contributes to patient selection, focus localization and ultimately long-term seizure freedom after epilepsy surgery. Specifically in extra-temporal lobe epilepsy and non-lesional cases, magnetoencephalography provides excellent accuracy.


Language(s): eng - English
 Dates: 2019-05-292019-01-072019-06-022019-08-022019-10
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1093/brain/awz231
PMID: 31373622
Other: Epub ahead of print
 Degree: -



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Project name : -
Grant ID : RA 2062/1–1 ; WO 1425/7–1
Funding program : -
Funding organization : Deutsche Forschungsgemeinschaft (DFG)
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Funding program : -
Funding organization : Förderverein Neurochirurgische Forschung of the University Hospital Erlangen

Source 1

Title: Brain
  Other : Brain
Source Genre: Journal
Publ. Info: London : Macmillan
Pages: - Volume / Issue: 142 (10) Sequence Number: - Start / End Page: 3059 - 3071 Identifier: ISSN: 0006-8950
CoNE: https://pure.mpg.de/cone/journals/resource/954925385135