Diagnostic and prognostic value of noninvasive long-term video-electroencephalographic monitoring in epilepsy surgery: A systematic review and meta-analysis from the E-PILEPSY consortium
Kobulashvili, Teia; Kuchukhidze, Giorgi; Brigo, Francesco; Zimmermann, Georg; Höfler, Julia; Leitinger, Markus; Dobesberger, Judith; Kalss, Gudrun; Rohracher, Alexandra; Neuray, Caroline; Wakonig, Antonia; Ernst, Florian; Braun, Kees P.J.; Mouthaan, Brian E.; Van Eijsden, Pieter; Ryvlin, Philippe; Cross, J. Helen; Trinka, Eugen; on behalf of the E-PILEPSY consortium
(2018) Epilepsia, volume 59, issue 12, pp. 2272 - 2283
(Article)
Abstract
Objective: The European Union–funded E-PILEPSY network (now continuing within the European Reference Network for rare and complex epilepsies [EpiCARE]) aims to harmonize and optimize presurgical diagnostic procedures by creating and implementing evidence-based guidelines across Europe. The present study evaluates the current evidence on the diagnostic accuracy of long-term video-electroencephalographic monitoring
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(LTM) in identifying the epileptogenic zone in epilepsy surgery candidates. Methods: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched for relevant articles. First, we used random-effects meta-analytical models to calculate pooled estimates of sensitivity and specificity with respect to postsurgical seizure freedom. In a second phase, we analyzed individual patient data in an exploratory fashion, assessing diagnostic accuracy within lesional and nonlesional temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) patients. We also evaluated seizure freedom rate in the presence of “localizing” or “nonlocalizing” LTM within each group. The quality of evidence was assessed using the QUADAS-2 tool and the GRADE approach. Results: Ninety-four studies were eligible. Forty-four were included in sensitivity meta-analysis and 34 in specificity meta-analysis. Pooled sensitivity was 0.70 (95% confidence interval [CI] = 0.60-0.80) and specificity was 0.40 (95% CI = 0.27-0.54). Subgroup analysis was based on individual data of 534 patients (41% men). In lesional TLE patients, sensitivity was 0.85 (95% CI = 0.81-0.89) and specificity was −0.19 (95% CI = 0.13-0.28). In lesional ETLE patients, a sensitivity of 0.47 (95% CI = 0.36-0.58) and specificity of 0.35 (95% CI = 0.21-0.53) were observed. In lesional TLE, if LTM was localizing and concordant with resection site, the seizure freedom rate was 247 of 333 (74%), whereas in lesional ETLE it was 34 of 56 (61%). The quality of evidence was assigned as “very low.”. Significance: Long-term video-electroencephalographic monitoring is associated with moderate sensitivity and low specificity in identification of the epileptogenic zone. Sensitivity is remarkably higher in lesional TLE compared to lesional ETLE. Substantial heterogeneity across the studies indicates the need for improved design and quality of reporting.
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Keywords: epilepsy surgery, seizure outcome, sensitivity, specificity, video-EEG, Neurology, Clinical Neurology
ISSN: 0013-9580
Publisher: Wiley-Blackwell
Note: Funding Information: European Union grant agreement 20131203, in the framework of the Health Program Funding Information: This publication arose from the project E‐PILEPSY, which has received funding from the European Union (grant agreement 20131203) in the framework of the Health Program (2008‐2013). Funding Information: A.R. has received travel support and speaker honoraria from Eisai. C.N. has received travel support and speaker honoraria from Eisai. F.B. has received speaker honoraria from Eisai and Peer Voice, payment for consultancy from Eisai, and travel support from Eisai, ITALFARMACO, and UCB Pharma. G.Z. has received travel support from Eisai. J.H.C. has received remuneration to her department as a clinical investigator for Vitaflo, GW Pharma, and Zogenix. She has participated in advisory boards for UCB Pharma, Zogenix, GW Pharma, Nutricia, Takeda, and Eisai, and as a speaker for Shire, Nutricia, Zogenix, Nutricia, Biomarin, and GW Pharma, again for which remuneration was made to her department. She holds grants from the European Union, National Institute for Health and Research, Action Medical Research, Engineering and Physical Sciences Research Council, Epilepsy Research UK, Great Ormond Street Hospital Charity, and SPARKS. M.L. has received speaker honoraria from Eisai and Everpharma, and travel grants from Medtronic and UCB Pharma. The remaining authors have no conflicts of interest to report. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Publisher Copyright: © 2018 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
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