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Doctoral Thesis
DOI
10.11606/T.17.2017.tde-05012017-092914
Document
Author
Full name
Bruno Zanotelli Monnerat
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2016
Supervisor
Committee
Sakamoto, Américo Ceiki (President)
Caboclo, Luis Otavio Sales Ferreira
Cendes, Fernando
Santos, Antonio Carlos dos
Velasco, Tonicarlo Rodrigues
Title in Portuguese
Convergência da videoeletroencefalografia prolongada e da ressonância magnética de encéfalo na determinação de zonas epileptogênicas extrahipocampais presumidas
Keywords in Portuguese
acurácia
cirurgia de epilepsia
displasia cortical
epilepsia
imagem de ressonância magnética
videoeletroencefalografia
Abstract in Portuguese
Pacientes com epilepsia farmacorresistente, frequentemente, possuem lesões extrahipocampais como etiologia. Muitas vezes, estes pacientes se beneficiam de lesionectomias para redução da ocorrência de crises epilépticas. Para que possam se submeter a este procedimento, atualmente é necessário o uso tanto da videoeletroencefalografia prolongada (VEEG) quanto da imagem de ressonância magnética do encéfalo (IRM) para delimitação apurada da zona epileptogênica, local que deve ser ressecado para controle das crises. No presente trabalho, foi estudada a acurácia diagnóstica da VEEG e da IRM na determinação da zona epileptogênica de pacientes com displasia cortical focal. Comparou-se os locais de ocorrência da zona de início ictal (VEEG) e da lesão epileptogênica (IRM) se concordantes ou discordantes com o local da cirurgia. Foram revisados os prontuários médicos de 209 pacientes, sendo o padrão de referência (local da cirurgia) e tempo de acompanhamento pós-operatório superior a 12 meses disponíveis em 43 pacientes. A VEEG apresentou sensibilidade de 85,7% (IC 95% 62,6-96,2) e especificidade de 41,1% (IC 95% 19,4-66,5), com valor preditivo positivo de 64,2% (IC 95% 44,1-80,6) e valor preditivo negativo de 70% (IC 95% 35,3-91,9). A IRM apresentou sensibilidade de 91,6% (IC 95% 71,5-98,5) e especificidade de 36,8% (IC 95% 17,2-61,3), com valor preditivo positivo de 64,7% (IC 95% 46,4-79,6) e valor preditivo negativo de 77,7% (IC 95% 40,1-96). As diferenças de sensibilidade e especificidade, áreas sob as curvas ROC e os índices de Youden não foram significativas. A concordância dos resultados da VEEG e da IRM foi moderada (k=0,599; p<0,01; IC 95% 0,468-0,730).
Title in English
The convergence of long-term videoelectroencefalography and brain magnetic resonance imaging in the delineation of presumed extrahippocampal epileptogenic zones
Keywords in English
accuracy
cortical dysplasia
epilepsy
magnetic resonance imaging. epilepsy surgery
videoelectroencephalography
Abstract in English
Patients with drug-resistant epilepsy frequently have extrahippocampal lesions as etiology. A large proportion of these patients might benefit from lesionectomy for the reduction of seizures. For surgery to be undertaken, it is usually performed both long-term videoelectroencephalography monitoring (VEEG) and magnetic resonance imaging of the brain (MRI) for the precise delimitation of the epileptogenic zone, the region that must be resected for seizure control. In the present study, the diagnostic accuracy of VEEG and MRI were studied in the localization of the epileptogenic zone in patients with focal cortical dysplasia. The seizure-onset zone (VEEG) and the region of epileptogenic lesion (MRI) were compared whereas concordant or discordant regarding surgery region. Medical charts of 209 patients were reviewed, being the reference standard (surgery region) and post-surgical follow-up longer than 12 months available in 43 patients. Videoelectroencephalography has a sensitivity of 85.7% (95% CI 62.6-96.2) and specificity of 41.1% (95% CI 19.4-66.5), with positive predictive value of 64.2% (95% CI 44.1-80.6) and negative predictive value of 70% (95% CI 35.3-91.9). Magnetic resonance imaging has a sensitivity of 91.6% (95% CI 71.5-98.5) and specificity of 36.8% (95% CI 17.2-61.3), with positive predictive value of 64.7% (95% CI 46.4-79.6) and negative predictive value of 77.7% (95% CI 40.1-96). The differences of sensitivity and specificity, areas under the ROC curves and Youden's indexes were not significant. The concordance between the results of VEEG and MRI was moderate (k=0.599; p<0.01; 95% CI 0.468-0.730).
 
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Publishing Date
2017-02-21
 
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