HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Antel, S. B. Articles by Arnold, D. L. Search for Related Content PubMed PubMed Citation Articles by Antel, S. B. Articles by Arnold, D. L. Related Collections Outcome research MRI MRS All Epilepsy/Seizures Epilepsy surgery Complex partial seizures

Predicting surgical outcome in temporal lobe epilepsy patients using MRI and MRSI

From the Departments of Biomedical Engineering (Drs. Collins and Kearney, and S.B. Antel) and Neurology and Neurosurgery (Drs. Li, Cendes, Collins, and Arnold), McGill University; MR Spectroscopy Unit (Drs. Li, Cendes, and Arnold, and S.B. Antel), Montreal Neurological Institute and Hospital; and Department of Computer Science (Dr. Shinghal), Concordia University, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Douglas L. Arnold, MR Spectroscopy Unit, Montreal Neurologic Institute, 3801 University St., Montreal, PQ H3A 2B4, Canada; e-mail: doug{at}mrs.mni.mcgill.ca

Objective: To develop a classifier that uses MR data to predict surgical outcome in patients with temporal lobe epilepsy (TLE).

Methods: Eighty-one patients with medically refractory TLE who underwent surgical treatment were studied. Patients underwent comprehensive presurgical investigation, including ictal video-EEG recording, ¹H MRS imaging, and volumetric MRI. Outcome was measured using Engel’s classification system, condensed into two outcome groups. Two approaches were taken. First, outcome was defined as experiencing worthwhile improvement with >90% reduction of seizure frequency (Classes I, II, and III) or not (Class IV). A second approach was to define outcome as experiencing freedom from seizures following surgery (Class I) or not (Classes II, III, and IV). For each approach, a Bayesian classifier was constructed to predict outcome by calculating the probability of a patient’s pattern of results from spectroscopic analysis of the temporal lobes and volumetric analysis of the amygdala and hippocampus being associated with the various outcome groups.

Results: The worthwhile improvement classifier correctly predicted the surgical outcomes of 60 of 65 (92%) of patients who experienced worthwhile improvement and 10 of 16 (63%) of patients who did not. The seizure-free classifier correctly predicted the surgical outcomes of 39 of 52 (75%) of patients who became seizure free and 21 of 29 (72%) of patients who did not.

Conclusion: MR features are important markers of surgical outcome in patients with TLE and can provide assistance in identifying surgical candidates.

This article has been cited by other articles:

				P.M. G. Pereira, E. Oliveira, and P. Rosado Apparent Diffusion Coefficient Mapping of the Hippocampus and the Amygdala in Pharmaco-Resistant Temporal Lobe Epilepsy AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 671 - 683. [Abstract] [Full Text] [PDF]

				H Clusmann, T Kral, E Fackeldey, I Blumcke, C Helmstaedter, J von Oertzen, H Urbach, and J Schramm Lesional mesial temporal lobe epilepsy and limited resections: prognostic factors and outcome J. Neurol. Neurosurg. Psychiatry, November 1, 2004; 75(11): 1589 - 1596. [Abstract] [Full Text] [PDF]