Assessment and cost comparison of sleep-deprived EEG, MRI and PET in the prediction of surgical treatment for epilepsy. Seizure 2002 Jul;11(5):303-9
Date
06/22/2002Pubmed ID
12076102DOI
10.1053/seiz.2001.0648Scopus ID
2-s2.0-0036631176 (requires institutional sign-in at Scopus site) 34 CitationsAbstract
Our aim was to determine if less expensive interictal indices can predict which epilepsy patients may benefit from the more expensive comprehensive pre-surgical evaluation. Surgical treatment was determined based on the results of a comprehensive inpatient continuous video-EEG monitoring. This evaluation included three interictal tests, which were reviewed retrospectively-2 hour-sleep-deprived electroencephalogram (SDEEG), magnetic resonance imaging (MRI), and positron emission tomography (PET). Sixty-nine patients were evaluated with 35 patients having focal resection (33 temporal, two frontal). When two or more interictal tests were positive, 77% (27 /35) went to surgery, but when one test was positive 23% (8 /34) had surgery. When all tests were negative, only a single patient (1 /13 or 7.7%) had surgery, a frontal resection. The positive predictive value for any single interictal test was 68%, while it was higher for any combination of two positive tests (77-83%). PET was the most sensitive (0.86) single interictal test, compared to SDEEG (0.66) and MRI (0.66). The odds ratio for predicting surgical treatment for a positive PET, SDEEG, or MRI was 8.57, 4.01, and 4.01, respectively. MRI was three and PET was six times the cost of a SDEEG. The combination of SDEEG and MRI had the best cost/PPV ratio. Seventy-nine percent (11 /14) of the patients with three positive tests were seizure free following focal resection compared to 43% (9 /21) when less than three tests were positive ( P<or= 0.05). Interictal tests may predict which patients are most likely to benefit from comprehensive pre-surgical evaluation. Two or more positive tests are the most predictive. If all tests are negative, it is unlikely that the patient would qualify for surgical treatment. The combination of SDEEG and MRI may be more cost-effective as outpatient screening tools.
Author List
DellaBadia J Jr, Bell WL, Keyes JW Jr, Mathews VP, Glazier SSAuthor
Vincent Mathews MD Chair, Professor in the Radiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Child
Costs and Cost Analysis
Electroencephalography
Epilepsy
Female
Follow-Up Studies
Forecasting
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Odds Ratio
Retrospective Studies
Sleep Deprivation
Tomography, Emission-Computed
