A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery

Abstract

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Interictal SPECT in the presurgical evaluation in epileptic patients with normal MRI or bilateral mesial temporal sclerosis

“…An association between hypoperfusion in the interictal SPECT and hyperperfusion in the ictal SPECT was the commonest finding during the PSAE 16 . however we found variations such as hyperperfusion in the interictal SPECT, even when no seizures were identified within the previous 24 hours or of Periodic Lateralized Epileptiform discharges (PLEd), which may be responsible for this change in the scintigraphic pattern as has been reported in publications in approximately 5% of interictal studies 14 .…”

“…Refractory epilepsy patients generally present with a scintigraphic pattern of cerebral hypoperfusion 11,12 , normal cerebral perfusion 13 or, infrequently, hyperperfusion 14 during the interictal period (outside of seizure) and cerebral hyperperfusion 11,[15][16][17] of the same area during the ictal period (during the seizures).…”

The Utility of Positron Emission Tomography in Epilepsy

“…Several reports in the past have indicated that PET is safe and may benefit a subset of patients undergoing surgery, [4][5][6] whereas another report concluded that there is a lack of evidence on the effectiveness and cost-effectiveness of imaging techniques (including PET) in the presurgical workup to inform clinical practice. 7 As a result, the purpose of the present study was to systematically review the literature to assess the diagnostic accuracy and clinical utility of PET in the presurgical evaluation of adult and pediatric patients with medically intractable epilepsy.…”

The clinical effectiveness and cost-effectiveness of technologies used to visualise the seizure focus in people with refractory epilepsy being considered for surgery: a systematic review and decision-analytical model.

“…34 In the evaluation of diagnostic technologies used in the work-up for epilepsy surgery, the need for follow-up studies to quantify the effect of a diagnostic technology on patient outcome is particularly important because a reliable independent reference standard is not available. 36,37 The prior HTA report highlighted further serious limitations with the data from the diagnostic accuracy studies in imaging technologies used in the work-up for epilepsy surgery: ■ There is no established, reliable, reference standard test against which a new test can be compared.…”

“…In 2006, an HTA report 36 was published of a broad-ranging systematic review that evaluated neuroimaging technologies used to identify the seizure focus in patients with refractory epilepsy being considered for surgery. The prior HTA report highlighted a number of limitations of the evidence available at that time.…”