Association Between Magnetoencephalography-Localized Epileptogenic Zone, Surgical Resection Volume, and Postsurgical Seizure Outcome.

Abstract

Surgical resection of magnetoencephalography (MEG) dipole clusters, reconstructed from interictal epileptiform discharges, is associated with favorable seizure outcomes. However, the relation of MEG cluster resection to the surgical resection volume is not known nor is it clear whether this association is direct and causal, or it may be mediated by the resection volume or other predictive factors. This study aims to clarify these open questions and assess the diagnostic accuracy of MEG in our center. We performed a retrospective cohort study of 68 patients with drug-resistant epilepsy who underwent MEG followed by resective epilepsy surgery and had at least 12 months of postsurgical follow-up. Good seizure outcomes were associated with monofocal localization (χ2 = 6.94, P = 0.001; diagnostic odds ratio = 10.2) and complete resection of MEG clusters (χ2 = 22.1, P < 0.001; diagnostic odds ratio = 42.5). Resection volumes in patients with and without removal of MEG clusters were not significantly different (t = 0.18, P = 0.86; removed: M = 20,118 mm3, SD = 10,257; not removed: M = 19,566 mm3, SD = 10,703). Logistic regression showed that removal of MEG clusters predicts seizure-free outcome independent of the resection volume and other prognostic factors (P < 0.001). Complete resection of MEG clusters leads to favorable seizure outcomes without affecting the volume of surgical resection and independent of other prognostic factors. MEG can localize the epileptogenic zone with high accuracy. MEG interictal epileptiform discharges mapping should be used whenever feasible to improve postsurgical seizure outcomes.