Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.
Austrian Institute of Technology GmbH (AIT), Safety & Security Department, Vienna, Austria.
Clin Neurophysiol. 2018 Jun;129(6):1291-1299. doi: 10.1016/j.clinph.2018.03.020. Epub 2018 Apr 6.
To test the diagnostic accuracy of a new automatic algorithm for ictal onset source localization (IOSL) during routine presurgical epilepsy evaluation following STARD (Standards for Reporting of Diagnostic Accuracy) criteria.
We included 28 consecutive patients with refractory focal epilepsy (25 patients with temporal lobe epilepsy (TLE) and 3 with extratemporal epilepsy) who underwent resective epilepsy surgery. Ictal EEG patterns were analyzed with a novel automatic IOSL algorithm. IOSL source localizations on a sublobar level were validated by comparison with actual resection sites and seizure free outcome 2 years after surgery.
Sensitivity of IOSL was 92.3% (TLE: 92.3%); specificity 60% (TLE: 50%); positive predictive value 66.7% (TLE: 66.7%); and negative predictive value 90% (TLE: 85.7%). The likelihood ratio was more than ten times higher for concordant IOSL results as compared to discordant results (p = 0.013).
We demonstrated the clinical feasibility of our IOSL approach yielding reasonable high performance measures on a sublobar level.
Our IOSL method may contribute to a correct localization of the seizure onset zone in temporal lobe epilepsy and can readily be used in standard epilepsy monitoring settings. Further studies are needed for validation in extratemporal epilepsy.
根据 STARD（诊断准确性报告标准）标准，测试一种新的发作起始源定位（IOSL）自动算法在常规术前癫痫评估中的诊断准确性。
我们纳入了 28 例难治性局灶性癫痫患者（25 例颞叶癫痫和 3 例颞外癫痫），这些患者均接受了切除术治疗。采用新的自动 IOSL 算法分析癫痫发作期脑电图模式。通过与实际切除部位和术后 2 年无癫痫发作结果的比较，对亚叶水平的 IOSL 源定位进行验证。
IOSL 的敏感性为 92.3%（TLE：92.3%）；特异性为 60%（TLE：50%）；阳性预测值为 66.7%（TLE：66.7%）；阴性预测值为 90%（TLE：85.7%）。与不一致的 IOSL 结果相比，一致的 IOSL 结果的似然比高出十倍以上（p=0.013）。
我们证明了我们的 IOSL 方法在亚叶水平上具有合理的高性能指标的临床可行性。
我们的 IOSL 方法可能有助于正确定位颞叶癫痫的癫痫发作起始区，并且可以在标准的癫痫监测环境中得到很好的应用。需要进一步的研究来验证颞外癫痫的验证。
