Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Epilepsia. 2020 Sep;61(9):1958-1968. doi: 10.1111/epi.16637. Epub 2020 Aug 8.
One of the greatest challenges of achieving successful surgical outcomes in patients with epilepsy is the ability to properly localize the seizure onset zone (SOZ). Many techniques exist for localizing the SOZ, including intracranial electroencephalography, magnetoencephalography, and stereoelectroencephalography. Recently, resting-state functional magnetic resonance imaging (rs-fMRI) in conjunction with independent component analysis (ICA) has been utilized for presurgical planning of SOZ resection, with varying results. In this meta-analysis, we analyze the current role of rs-fMRI in identifying the SOZ for presurgical planning for patients with drug-resistant epilepsy. Specifically, we seek to demonstrate its current effectiveness compared to other methods of SOZ localization.
A literature review was conducted using the PubMed, MEDLINE, and Embase databases up to May of 2020. A total of 253 articles were screened, and seven studies were chosen for analysis. Each study was analyzed for SOZ localization by ground truth, SOZ localization by rs-fMRI with ICA, principal component analysis, or intrinsic connectivity contrast, and outcomes of surgery. A meta-analysis was performed to analyze how ground truth compares to rs-fMRI in SOZ localization.
The odds ratio comparing ground truth to rs-fMRI was 2.63 (95% confidence interval = 0.66-10.56). Average concordance of rs-fMRI SOZ localization compared with ground truth localization across studies was 71.3%.
In the hunt for less invasive presurgical planning for epilepsy surgery, rs-fMRI with ICA provides a promising avenue for future standard practice. Our preliminary results show no significant difference in surgical outcomes between traditional standards of SOZ localization and rs-fMRI with ICA. We believe that rs-fMRI could be a step forward in this search. Further investigation comparing rs-fMRI to traditional methods of SOZ localization should be conducted, with the hope of moving toward relying solely on noninvasive screening methods.
在癫痫患者中实现成功手术结果的最大挑战之一是正确定位发作起始区 (SOZ) 的能力。有许多技术可用于定位 SOZ，包括颅内脑电图、脑磁图和立体脑电图。最近，静息态功能磁共振成像 (rs-fMRI) 结合独立成分分析 (ICA) 已被用于 SOZ 切除的术前规划，结果不一。在这项荟萃分析中，我们分析了 rs-fMRI 在识别耐药性癫痫患者术前计划中 SOZ 的当前作用。具体来说，我们旨在证明其与其他 SOZ 定位方法相比的当前有效性。
使用 PubMed、MEDLINE 和 Embase 数据库进行文献回顾，截至 2020 年 5 月。共筛选出 253 篇文章，选择了 7 篇进行分析。对每篇研究的 SOZ 定位进行了分析，包括通过地面实况、通过 rs-fMRI 与 ICA、主成分分析或内在连通性对比进行 SOZ 定位以及手术结果。进行了荟萃分析，以分析地面实况与 rs-fMRI 在 SOZ 定位中的比较。
比较地面实况与 rs-fMRI 的优势比为 2.63（95%置信区间=0.66-10.56）。各研究中 rs-fMRI SOZ 定位与地面实况定位的平均一致性为 71.3%。
在寻找癫痫手术的微创性术前规划中，带 ICA 的 rs-fMRI 为未来的标准实践提供了一个有前途的途径。我们的初步结果显示，传统的 SOZ 定位标准与带 ICA 的 rs-fMRI 之间的手术结果无显著差异。我们相信 rs-fMRI 可能是这一探索的一个进步。应进行进一步的研究，将 rs-fMRI 与 SOZ 定位的传统方法进行比较，希望朝着仅依靠非侵入性筛选方法的方向发展。
