Toward the Substitution of Invasive Electroencephalography in Epilepsy Surgery

The authors compared the localization accuracy of interictal magnetoencephalography (MEG) with ictal and interictal invasive video electroencephalography (VEEG) in identifying the epileptogenic zone in epilepsy surgery candidates. Forty-one patients, 29 with temporal lobe epilepsy (TLE) and 12 with extratemporal lobe epilepsy (ETLE), participated. Only patients with interictal changes during the MEG recordings were included. A comparison of the accuracy of invasive VEEG and MEG seizure zone identification was based on the degree of overlap between the location of the actual surgical resection and the zone identified by each method, and the success of surgery in reducing seizure activity. No statistical differences were observed between the accuracy of invasive VEEG and MEG in determining the location of the seizure zone across TLE and ETLE cases. Invasive VEEG and MEG localization judgments were correct in 54% and 56% of the cases, respectively. Separate group analyses suggested that MEG may be less beneficial relative to invasive VEEG in ETLE than TLE cases. MEG is of statistically equivalent accuracy to invasive VEEG, despite the fact that its use has not reached optimal conditions. The authors predict the replacement of the more invasive procedure with MEG in the near future for TLE cases, subsequent to the optimization of the conditions under which preoperative MEG is performed.