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.

Abstract

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Source localization of rhythmic ictal EEG activity: A study of diagnostic accuracy following STARD criteria

“…Recently published critical reviews emphasized the difficulties in the interpretation of diagnostic accuracy studies on presurgical workup for epilepsy surgery, and it was suggested to supplement the currently available imperfect reference standard (consensus decision from a combination of tests) with the outcome following surgery (Burch et al., ,b). The likelihood ratios calculated from these tables reflect the clinical usefulness of the index test.…”

“…For determining the diagnostic accuracy of ictal source localization, the reference standard for localizing the seizure‐onset zone was the consensus conclusion of the local multidisciplinary epilepsy surgery team (Rosenow & Lüders, ; Burch et al., ,b). The team included experienced, board‐certified clinical neurophysiologists, epileptologists, and neuropsychologists who evaluated the video‐EEG recordings, able to change between different montages, and who had access to all clinical and neuroimaging data interpreted by an experienced neuroradiologist.…”

“…To estimate the clinical value of the ictal source analysis, we calculated likelihood ratios based on contingency tables (Burch et al., ,b). In this study only complete match between the index test (LAURA) and reference standard was considered “concordant.” Therefore, “partial concordant” and “discordant” results (Burch et al., ,b) were combined into the same category. Because all included data yielded a localization solution, we did not have patients in the “nonlocalizing” category.…”

Role of Oxidative Stress in Refractory Epilepsy: Evidence in Patients and Experimental Models

“…In patients with refractory epilepsy, current treatments include surgical resection of areas affecting epilepsy [139–142] and the ketogenic diet or other alternative diets used since the 1970s [143–146]. However, the refractoriness of epilepsy continues to be an unresolved problem.…”

The Utility of Positron Emission Tomography in Epilepsy

“…2 For most individuals affected by epilepsy, seizures can be brought under control by drug therapy; however, up to 20-30% of patients do not respond to medication and surgical resection of the epileptic focus may be considered. 3 The initial stage of the workup for surgery usually involves a series of tests to isolate the brain region responsible for the occurrence of seizures. Standard assessment consists of history and physical examination, prolonged scalp video-electroencephalogram (EEG) in an epilepsy monitoring unit, magnetic resonance imaging (MRI) of the brain, and neuropsychological testing.…”