Source localization of rhythmic ictal EEG activity: A study of diagnostic accuracy following STARD criteria

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Beniczky, Sandor (author)

Source localization of rhythmic ictal EEG activity: A study of diagnostic accuracy following STARD criteria

Article/chapterEnglish2013

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2013-08-14
Wiley,2013

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LIBRIS-ID:oai:lup.lub.lu.se:d5e0e0a1-10e5-4c57-86ec-89a3338020cc
https://lup.lub.lu.se/record/4171995URI
https://doi.org/10.1111/epi.12339DOI

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Language:English
Summary in:English

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PurposeAlthough precise identification of the seizure-onset zone is an essential element of presurgical evaluation, source localization of ictal electroencephalography (EEG) signals has received little attention. The aim of our study was to estimate the accuracy of source localization of rhythmic ictal EEG activity using a distributed source model. MethodsSource localization of rhythmic ictal scalp EEG activity was performed in 42 consecutive cases fulfilling inclusion criteria. The study was designed according to recommendations for studies on diagnostic accuracy (STARD). The initial ictal EEG signals were selected using a standardized method, based on frequency analysis and voltage distribution of the ictal activity. A distributed source modellocal autoregressive average (LAURA)was used for the source localization. Sensitivity, specificity, and measurement of agreement (kappa) were determined based on the reference standardthe consensus conclusion of the multidisciplinary epilepsy surgery team. Predictive values were calculated from the surgical outcome of the operated patients. To estimate the clinical value of the ictal source analysis, we compared the likelihood ratios of concordant and discordant results. Source localization was performed blinded to the clinical data, and before the surgical decision. Key FindingsReference standard was available for 33 patients. The ictal source localization had a sensitivity of 70% and a specificity of 76%. The mean measurement of agreement (kappa) was 0.61, corresponding to substantial agreement (95% confidence interval (CI) 0.38-0.84). Twenty patients underwent resective surgery. The positive predictive value (PPV) for seizure freedom was 92% and the negative predictive value (NPV) was 43%. The likelihood ratio was nine times higher for the concordant results, as compared with the discordant ones. SignificanceSource localization of rhythmic ictal activity using a distributed source model (LAURA) for the ictal EEG signals selected with a standardized method is feasible in clinical practice and has a good diagnostic accuracy. Our findings encourage clinical neurophysiologists assessing ictal EEGs to include this method in their armamentarium.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Neurologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Neurology hsv//eng
EEG
Epilepsy
Seizure
Sensitivity
Specificity
Predictive value

Added entries (persons, corporate bodies, meetings, titles ...)

Lantz, Goran (author)
Rosenzweig, Ivana (author)
Åkeson, PerLund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,Radiology Diagnostics, Malmö,Lund University Research Groups(Swepub:lu)ront-pak (author)
Pedersen, Birthe (author)
Pinborg, Lars H. (author)
Ziebell, Morten (author)
Jespersen, Bo (author)
Fuglsang-Frederiksen, Anders (author)
Diagnostisk radiologi, MalmöForskargrupper vid Lunds universitet (creator_code:org_t)

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In:Epilepsia: Wiley54:10, s. 1743-17520013-9580

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By the author/editor: Beniczky, Sandor; Lantz, Goran; Rosenzweig, Ivan ...; Åkeson, Per; Pedersen, Birthe; Pinborg, Lars H.; show more...; Ziebell, Morten; Jespersen, Bo; Fuglsang-Frederi ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Neurology

Articles in the publication: Epilepsia

By the university: Lund University

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