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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522-530. Review/Other-Dx N/A To recognize that some seizure types can have either a focal or generalized onset, to allow classification when the onset is unobserved, to include some missing seizure types, and to adopt more transparent names. Changes include the following: (1) "partial" becomes "focal"; (2) awareness is used as a classifier of focal seizures; (3) the terms dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are eliminated; (4) new focal seizure types include automatisms, behavior arrest, hyperkinetic, autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be of either focal or generalized onset; (6) focal to bilateral tonic-clonic seizure replaces secondarily generalized seizure; (7) new generalized seizure types are absence with eyelid myoclonia, myoclonic absence, myoclonic-atonic, myoclonic-tonic-clonic; and (8) seizures of unknown onset may have features that can still be classified. The new classification does not represent a fundamental change, but allows greater flexibility and transparency in naming seizure types. 4
2. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Epilepsy Data and Statistics.  Available at: https://www.cdc.gov/epilepsy/data/index.html. Review/Other-Dx N/A To review the epilepsy data and statistics by the National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. No results stated in the abstract. 4
3. World Health Organization. Epilepsy.  Available at: https://www.who.int/news-room/fact-sheets/detail/epilepsy. Review/Other-Dx N/A To discuss World Health Organization resolution on epilepsy. No results stated in the abstract. 4
4. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58:512-21. Observational-Dx N/A To discuss the report of the Commission on Epidemiology of the International League Against Epilepsy (ILAE) task force on epilepsy. No results stated in the abstract. 4
5. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015;56:1515-23. Review/Other-Dx N/A To report  the Commission on Epidemiology of the International League Against Epilepsy (ILAE) on classification of Epilepsy. No results stated in the abstract. 4
6. Jackson GD, Kuzniecky RI. Chapter 79: Structural Neuroimaging. In: Engel J, Pedley TA, eds. Epilepsy: A Comprehensive Textbook. 2 ed. Philadelphia PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2008. Review/Other-Dx N/A Book chapter. N/A 4
7. Wyllie E, Gupta A, Lachhwani DK. The Treatment of Epilepsy: Principles and Practice. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. Review/Other-Dx N/A N/A N/A 4
8. Sarikaya I. PET studies in epilepsy. Am J Nucl Med Mol Imaging 2015;5:416-30. Review/Other-Dx N/A To discuss PET studies in epilepsy. No results stated in the abstract. 4
9. Chagnac-Amitai Y, Connors BW. Horizontal spread of synchronized activity in neocortex and its control by GABA-mediated inhibition. J Neurophysiol 1989;61:747-58. Review/Other-Dx N/A To discuss the horizontal spread of synchronized activity in neocortex and its control by GABA-mediated inhibition. No results stated in the abstract. 4
10. Tortella FC, Echevarria E, Robles L, Mosberg HI, Holaday JW. Anticonvulsant effects of mu (DAGO) and delta (DPDPE) enkephalins in rats. Peptides 1988;9:1177-81. Review/Other-Tx N/A The review of Anticonvulsant effects of mu (DAGO) and delta (DPDPE) enkephalins in rats. No results stated in the abstract. 4
11. Clinckers R, Smolders I, Meurs A, Ebinger G, Michotte Y. Anticonvulsant action of hippocampal dopamine and serotonin is independently mediated by D and 5-HT receptors. J Neurochem 2004;89:834-43. Review/Other-Tx N/A To review the Anticonvulsant action of hippocampal dopamine and serotonin is independently mediated by D and 5-HT receptors. No results stated in the abstract. 4
12. Starr MS. The role of dopamine in epilepsy. Synapse 1996;22:159-94. Review/Other-Tx N/A To discuss the role of dopamine in epilepsy. No results stated in the abstract. 4
13. Rubi S, Costes N, Heckemann RA, et al. Positron emission tomography with alpha-[11C]methyl-L-tryptophan in tuberous sclerosis complex-related epilepsy. Epilepsia. 54(12):2143-50, 2013 Dec. Observational-Dx 12 patients To reevaluate whether increased uptake of a-[(11) C]methyl-l-tryptophan (AMT) in cerebral tubers is associated with tuber epileptogenicity. A total of 126 tubers were identified. Two of 12 patients demonstrated a tuber with clearly increased AMT uptake, one of whom also showed a subtle increased AMT uptake in another contralateral tuber. Four other patients showed only subtle increased AMT uptake. The only two tubers with clearly increased AMT uptake proved to be epileptogenic based on intracerebral EEG data, whereas none of the tubers associated with subtle increased AMT uptake were involved at ictal onset. In a per-patient approach, this yielded a sensitivity of clearly increased AMT uptake in detecting tuber epileptogenicity of 17% (2/12 patients), whereas the per-lesion sensitivity and specificity were 12% (95% confidence interval [CI]: 3-34%) and 100% (95% CI: 97-100%), respectively. 2
14. Laskowitz D, Grant G. Translational Research in Traumatic Brain Injury. Boca Raton (FL); 2016. Review/Other-Dx N/A To cover a wide scope of TBI research in five broad areas: Epidemiology,  Pathophysiology, Diagnosis, Current treatment strategies and sequelae. and Future therapies. No results stated in the abstract. 4
15. Kuzniecky RI. Neuroimaging of epilepsy: therapeutic implications. NeuroRx 2005;2:384-93. Review/Other-Dx N/A To compare available imaging modalities, their specific role in patients with epilepsy, and practical applications of imaging data in the management of patients with epilepsy. No results stated in the abstract. 4
16. Likeman M.. Imaging in epilepsy. [Review]. Practical Neurology. 13(4):210-8, 2013 Aug. Review/Other-Dx N/A To review the use of neuroimaging in epilepsy outlining the imaging strategy for new onset seizures and also those with intractable focal seizures. No results stated in the abstract. 4
17. Cendes F, Theodore WH, Brinkmann BH, Sulc V, Cascino GD. Neuroimaging of epilepsy. [Review]. Handbook of Clinical Neurology. 136:985-1014, 2016. Review/Other-Dx N/A To highlight neuroimaging developments and innovations, and provide a comprehensive overview of the imaging strategies used to improve the care and management of people with epilepsy. No results stated in the abstract. 4
18. Lapalme-Remis S, Cascino GD. Imaging for Adults With Seizures and Epilepsy. Continuum (Minneap Minn) 2016;22:1451-79. Review/Other-Dx N/A To discuss structural and functional neuroimaging findings in patients with seizures and epilepsy. The role of neuroimaging in epilepsy depends on the appropriate clinical indication. In patients without known epilepsy presenting with acute seizures, structural imaging is essential to rule out an underlying etiology (eg, subdural hematoma) that may require a specific therapeutic intervention. In individuals with new or previously uninvestigated epilepsy, MRI serves multiple purposes, including identifying a causative focal lesion and helping to diagnose the epilepsy type. In a significant number of patients with epilepsy, the MRI results are normal or reveal indeterminate findings. For patients with drug-resistant focal epilepsy, functional neuroimaging techniques, such as fludeoxyglucose-positron emission tomography (FDG-PET), ictal single-photon emission computed tomography (SPECT), or functional MRI (fMRI), may assist in surgical planning, especially in patients with MRI-negative epilepsy, whose prognosis for a seizure-free outcome after surgery is worse than for patients with an epileptogenic lesion on structural MRI. 4
19. Wintermark M, Sanelli PC, Anzai Y, et al. Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. [Review]. J. Am. Coll. Radiol.. 12(2):e1-14, 2015 Feb. Review/Other-Dx N/A To suggest practical imaging recommendations for patients presenting with TBI across different practice settings and to simultaneously provide the rationale and background evidence supporting their use. These recommendations should ultimately assist referring physicians faced with the task of ordering appropriate imaging tests in particular patients with TBI for whom they are providing care. These recommendations should also help radiologists advise their clinical colleagues on appropriate imaging utilization for patients with TBI. 4
20. Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT, American College of Radiology Head Injury Institute. Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques. AJNR Am J Neuroradiol. 36(2):E1-E11, 2015 Feb. Review/Other-Dx N/A To review advanced neuroimaging techniques in the evaluation of patients with TBI. Advanced neuroimaging techniques, including MRI diffusion-tensor imaging, blood oxygen level–dependent fMRI, MRS, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with TBI when conventional non-contrast CT and MRI findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. 4
21. Abu Hamdeh S, Marklund N, Lannsjo M, et al. Extended Anatomical Grading in Diffuse Axonal Injury Using MRI: Hemorrhagic Lesions in the Substantia Nigra and Mesencephalic Tegmentum Indicate Poor Long-Term Outcome. J Neurotrauma. 2017;34:341-52. Observational-Dx 30 patients To quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I-hemispheric lesions, stage II-corpus callosum lesions, stage III-brainstem lesions, and stage IV-substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (=/<30 years). 2
22. Wu X, Kirov II, Gonen O, Ge Y, Grossman RI, Lui YW. MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update. Radiology. 279(3):693-707, 2016 Jun. Review/Other-Dx N/A To focus on magnetic resonance (MR) methods that have shown promise in demonstrating evidence of subtle brain injury in mild traumatic brain injury  (mTBI)not apparent at conventional imaging. Evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with threedimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen level– dependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition. 4
23. Wehner T, Luders H. Role of neuroimaging in the presurgical evaluation of epilepsy. J Clin Neurol 2008;4:1-16. Review/Other-Dx N/A To review the role of neuroimaging in the presurgical evaluation of epilepsy. No results stated in the abstract. 4
24. Drzezga A, Arnold S, Minoshima S, et al. 18F-FDG PET studies in patients with extratemporal and temporal epilepsy: evaluation of an observer-independent analysis. J Nucl Med 1999;40:737-46. Observational-Dx 49 patients To evaluate an observer-independent analysis of 18F-fluorodeoxyglucose (FDG) PET studies in patients with temporal or extratemporal epilepsy. In patients with temporal epilepsy, the sensitivity was comparable for visual and observer-independent analysis (three-dimensional SSP 86%, experienced observers 86%-90%, less experienced observers 77%-86%). In patients with extratemporal epilepsy, three-dimensional SSP showed a significantly higher sensitivity in detecting the epileptogenic focus (67%) than did visual analysis (experienced 33%-38%, each less experienced 19%). In temporal lobe epilepsy, there was moderate to good agreement between the localization found with three-dimensional SSP and the different observers. In patients with extratemporal epilepsy, there was a high interobserver variability and only a weak agreement between the localization found with three-dimensional SSP and the different observers. Although three-dimensional SSP detected multiple lesions more often than visual analysis, the determination of the highest deviation from the reference database allowed the identification of the epileptogenic focus with a higher accuracy than subjective criteria, especially in extratemporal epilepsy. 3
25. Gaillard WD, Bhatia S, Bookheimer SY, Fazilat S, Sato S, Theodore WH. FDG-PET and volumetric MRI in the evaluation of patients with partial epilepsy. Neurology 1995;45:123-6. Observational-Dx 18 patients To determine the sensitivity of FDG-PET and MRI in the evaluation of patients with partial epilepsy. Sixteen patients (89%) had regional hypometabolism, 11 (61%) had focal 1.5-tesla T2-weighted MRI (two structural abnormalities, nine hippocampal formation [HF] increased T2 signal), and nine (50%) had absolute HF atrophy ipsilateral to the temporal ictal focus. Ten (55%) had abnormal L/R HF ratios, nine ipsilateral to the EEG focus. All patients with abnormal MRI volumetric studies had focal PET abnormalities. Only seven had both abnormal HF volume ratios and T2 MRI (all increased HF T2 signal). There was a significant correlation between hippocampal volume and inferior mesial and lateral temporal lobe cerebral metabolic rate of glucose asymmetry index (p < 0.01), suggesting that hypometabolism may reflect hippocampal atrophy. 3
26. Kim YK, Lee DS, Lee SK, Chung CK, Chung JK, Lee MC. (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med 2002;43:1167-74. Observational-Dx 29 patients To examine the diagnostic performance of 18F-FDG PET in Frontal Lobe Epilepsy. MRI showed structural lesions in 15 patients and normal findings in 14. 18F-FDG PET correctly localized the epileptogenic zones in 16 patients (55%) by visual assessment. The sensitivity of 18F-FDG PET was 36% in patients without structural lesions on MRI and 73% in patients with structural lesions. On SPM analysis, using an uncorrected probability value of 0.005 as the threshold, the sensitivity of SPM analysis was 66%, which was not statistically different from the sensitivity of visual assessment. The sensitivity decreased according to the decrease in probability value. 3
27. Knowlton RC, Laxer KD, Ende G, et al. Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy. Ann Neurol 1997;42:829-37. Observational-Dx 25 cases and 25 controls To compare 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), hippocampal volumetry (HV), T2 relaxometry, and proton magnetic resonance spectroscopic imaging (1H-MRSI) in the presurgical neuroimaging lateralization of patients with nonlesional, electroencephalogram (EEG)-defined unilateral temporal lobe epilepsy (TLE) FDG-PET lateralized 87% of patients, HV 65%, N-acetyl aspartate (NAA)/(choline [Cho] + creatine [Cr]) 61%, and [NAA] 57%. Combined HV and NAA/(Cho + Cr) results lateralized 83% of the patients, a value similar to PET. Of 10 patients with normal magnetic resonance imaging (MRI) scans, 2 were lateralized with HV, 6 with FDG-PET, 4 with NAA/(Cho + Cr), and 3 with [NAA]. T2 relaxometry lateralized no patients without hippocampal atrophy. Bilateral abnormality was present in 29 to 33% of patients with 1H-MRSI measures and 17% with HV. Only hippocampal atrophy correlated with postoperative seizure-free outcome. 2
28. Suarez-Pinera M, Mestre-Fusco A, Ley M, et al. Perfusion SPECT, SISCOM and PET (18)F-FDG in the assessment of drug- refractory epilepsy patients candidates for epilepsy surgery. Revista Espanola de Medicina Nuclear e Imagen Molecular. 34(6):350-7, 2015 Nov-Dec. Observational-Dx 47 patients To establish: the reproducibility of visual ictal-interictal SPECT and SISCOM analysis altogether with the capacity of SPECT, SISCOM and PET to determine the epileptogenic zone. The ictal-interictal SPECT interobserver agreement was 91%, Kappa index 0.86, SISCOM (Analyze 7.0) interobserver agreement percentage was 82%, Kappa index 0.80, Analyze 7.0 showed a higher inconclusive results than visual SPECT analysis. SISCOM FocusDET interobserver agreement was 92%, Kappa index 0.87, with lower inconclusive results than Analyze 7.0. SPECT, SISCOM and PET combined findings identified 87% seizure onset zone: 79% temporal, 26% parieto-temporal and 7% frontal. 2
29. Spencer SS. The relative contributions of MRI, SPECT, and PET imaging in epilepsy. Epilepsia. 1994;35 Suppl 6:S72-89. Review/Other-Dx N/A Review roles of MRI, SPECT, and PET imaging in epilepsy. Functional imaging by PET or SPECT provides complementary information. Ideally these techniques should be used and interpreted together to improve the localization and understanding of epileptic brain. 4
30. Kumar A, Chugani HT. The Role of Radionuclide Imaging in Epilepsy, Part 1: Sporadic Temporal and Extratemporal Lobe Epilepsy. [Review]. Journal of Nuclear Medicine Technology. 45(1):14-21, 2017 03. Review/Other-Dx N/A To describe the role of radionuclide imaging in epilepsy. Radionuclide imaging can be particularly useful if MR imaging is either negative for lesions or shows several lesions of which only 1 or 2 are suspected to be epileptogenic and if electroencephalogram changes are equivocal or discordant with the structural imaging. Similarly, PET and SPECT can also be useful for evaluating the functional integrity of the rest of the brain and may provide useful information on the possible pathogenesis of the neurocognitive and behavioral abnormalities frequently observed in these patients. 4
31. Friedman E.. Epilepsy imaging in adults: getting it right. [Review]. AJR. American Journal of Roentgenology. 203(5):1093-103, 2014 Nov. Review/Other-Dx N/A To describe an MRI protocol optimized for epilepsy evaluation, common causes of epilepsy visualized on MR images of patients evaluated for medically intractable partial epilepsy, and the basic concepts of advanced imaging techniques in the evaluation of epilepsy. No results stated in the abstract. 4
32. Jeon TY, Kim JH, Lee J, Yoo SY, Hwang SM, Lee M. Value of Repeat Brain MRI in Children with Focal Epilepsy and Negative Findings on Initial MRI. Korean Journal of Radiology. 18(4):729-738, 2017 Jul-Aug. Observational-Dx 257 children To evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy. Repeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1). 3
33. Winston GP, Micallef C, Kendell BE, et al. The value of repeat neuroimaging for epilepsy at a tertiary referral centre: 16 years of experience. Epilepsy Research. 105(3):349-55, 2013 Aug. Observational-Dx 804 patients To evaluate the role of repeated imaging with improved MRI technology — an increase in field strength from 1.5 T to 3 T and superior head coils — in detecting pathology not previously seen. 804 patients underwent imaging on both scanners, the majority with focal epilepsy (87%). On repeat scanning at 3 T, 37% of scans were normal and 20% showed incidental findings. Positive findings included hippocampal sclerosis (13%), malformations of cortical development (8%), other abnormalities (4%) and previous surgery (18%). A total of 37 (5%) relevant new diagnoses were made on the 3 T scans not previously seen at 1.5 T. The most common new findings were hippocampal sclerosis, focal cortical dysplasia and dysembryoplastic neuroepithelial tumour. These findings affected patient management with several patients undergoing neurosurgery. 3
34. Panayiotopoulos CP. The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing; 2005. Review/Other-Dx N/A To detail the most recent advances in epileptic seizures, epileptic syndromes and their management. No results stated in the abstract. 4
35. Shah R, Vattoth S, Jacob R, et al. Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics. 32(5):1343-59, 2012 Sep-Oct. Review/Other-Dx N/A To describe the practical approach to imaging interpretation of radiation necrosis in the brain. No results stated in the abstract. 4
36. Wong TZ, van der Westhuizen GJ, Coleman RE. Positron emission tomography imaging of brain tumors. Neuroimaging Clin N Am 2002;12:615-26. Review/Other-Dx N/A To discuss positron emission tomography (PET) imaging of brain tumors. No results stated in the abstract. 4
37. Hojjati M, Badve C, Garg V, et al. Role of FDG-PET/MRI, FDG-PET/CT, and Dynamic Susceptibility Contrast Perfusion MRI in Differentiating Radiation Necrosis from Tumor Recurrence in Glioblastomas. J Neuroimaging. 28(1):118-125, 2018 01. Observational-Dx 24 patients To compare the utility of quantitative PET/MRI, dynamic susceptibility contrast (DSC) perfusion MRI (pMRI), and PET/CT in differentiating radiation necrosis (RN) from tumor recurrence (TR) in patients with treated glioblastoma multiforme (GBM). In 24 patients, 28 lesions were identified. For PET/MRI, relative mean  1.31 resulted in AUC of .94 with both sensitivity and negative predictive values (NPVs) of 100%. For pMRI, CBV max 3.32 yielded an AUC of .94 with both 3
38. Verma N, Cowperthwaite MC, Burnett MG, Markey MK. Differentiating tumor recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies. [Review]. Neuro-Oncology. 15(5):515-34, 2013 May. Review/Other-Dx N/A To discuss the possibility of computational approaches to investigate the usefulness of fine-grained imaging characteristics that are difficult to observe through visual inspection of images and propose a flexible treatment-planning algorithm that incorporates advanced functional imaging techniques when indicated by the patient’s routine follow-up images and clinical condition. No results stated in the abstract. 4
39. Hygino da Cruz LC Jr, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG. Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. [Review]. AJNR Am J Neuroradiol. 32(11):1978-85, 2011 Dec. Review/Other-Dx N/A To review pseudoprogression and pseudoresponse and describe how better understanding of these phenomena can aid interpretation. No results stated in the abstract. 4
40. Bogdanoff BM, Stafford CR, Green L, Gonzalez CF. Computerized transaxial tomography in the evaluation of patients with focal epilepsy. Neurology. 1975;25(11):1013-1017. Review/Other-Dx 50 consecutive unselected patients To examine the role of CTAT in the evaluation of patients with focal epilepsy. CTAT is useful in the evaluation and follow-up of patients with focal seizure disorders. 4
41. Gastaut H, Gastaut JL. Computerized transverse axial tomography in epilepsy. Epilepsia. 1976;17(3):325-336. Review/Other-Dx 401 patients Report findings with CTAT in patients with epilepsy. Findings on CTAT were correlated with the electroclinical form of epilepsy and with etiology. CTAT is useful in the evaluation of epilepsy. In 81/401 patients, CTAT revealed a cerebral lesion which had been missed in the other examinations and which had merely been suspected from the history. 4
42. Heinz ER, Heinz TR, Radtke R, et al. Efficacy of MR vs CT in epilepsy. AJR Am J Roentgenol. 1989;152(2):347-352. Observational-Dx 59 seizure patients To compare and determine the efficacy of CT, MRI and EEG in the detection of an epileptogenic focus. EEG was most sensitive (67%), MRI was next (53%), and CT was least sensitive (42%). MRI is considered the imaging procedure of choice for the detection of an epileptogenic focus in seizure patients. When indicated, CT may be performed as a second procedure to try to distinguish neoplasm from thrombosed vascular malformations and other lesions. 3
43. van Rooijen BD, Backes WH, Schijns OE, Colon A, Hofman PA. Brain imaging in chronic epilepsy patients after depth electrode (stereoelectroencephalography) implantation: magnetic resonance imaging or computed tomography?. Neurosurgery. 73(3):543-9, 2013 Sep. Observational-Dx 14 patients To compare the relative registration deviation between postimplantation CT and MRI with preimplantation MRI. The registration error of postimplantation imaging to preimplantation MRI was dependent on the algorithm used. After optimization, the smallest registration error was 1.22 ± 0.29 mm (mean ± SD) at the tip and 2.25 ± 1.18 mm at the base of the electrode. 4
44. Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure. 2007;16(6):509-520. Meta-analysis 46 studies To assess the predictive diagnostic added value of PET in preoperative epilepsy surgery evaluation for patients with TLE. The analyses were complicated by significant differences in study design and often by lack of precise patient data. Ipsilateral PET hypometabolism showed a predictive value of 86% for good outcome. The predictive value was 80% in patients with normal MRI and 72% in patients with nonlocalized ictal scalp EEG. In a selected population of 153 TLE patients with a follow-up of >12 months PET correlated well with other noninvasive diagnostic tests, but none of the odds ratios of any test combination was significant. M
45. Hwang SI, Kim JH, Park SW, et al. Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy. AJNR Am J Neuroradiol 2001;22:937-46. Observational-Dx 117 patients To compare the sensitivities of these three imaging methods for presurgical localization of neocortical epileptogenic foci. Overall, MR imaging, PET, and ictal SPECT correctly localized the lesions for 59.8%, 77.7%, and 70.3% of the patients, respectively, with a 38% concordance rate among the three methods. PET was most sensitive (71-100%) in detecting all substrates. MR imaging was as sensitive (100%) as PET in detecting tumor but was least sensitive (48.1%) in detecting neuronal migration disorder. Ictal SPECT was more sensitive (75.8%) than MR imaging in detecting neuronal migration disorder. Patients with imaging abnormalities achieved good outcomes in 81.4% of the cases, in contrast to 59.5% for those without imaging abnormalities (P <.05). 2
46. Elkins KC, Moncayo VM, Kim H, Olson LD. Utility of gray-matter segmentation of ictal-Interictal perfusion SPECT and interictal (18)F-FDG-PET in medically refractory epilepsy. Epilepsy Res 2017;130:93-100. Observational-Dx 25 patients To determine whether  limiting functional images to gray matter improves identification of small, subtle, or obscure cortical volumes of 18F-FDG-PET hypometabolism and eliminates hyperperfused seizure propagation pathways within white matter in ictal perfusion SPECT. With segmentation, 84% (21/25) of cases had at least one area identified on 18F-FDG-PET scan concordant with iEEG SOZ at sublobar or higher levels, and 72% (18/25) of cases had subgyral concordance with iEEG SOZ. Without segmentation, 60% (15/25) of cases had at least one area in 18F-FDG-PET scan concordant with iEEG SOZ at sublobar or higher levels, and 32% (8/25) with subgyral concordance. 83% (10/12) of seizure free patients had subgyral concordance on segmented 18F-FDG-PET. Both segmented and nonsegmented ictal-interictal SPECT perfusion clusters had 56% (14/25) of cases with at least sublobar concordance. Subgyral concordance was achieved by 28% (7/25) of segmented and 20% (5/25) of nonsegmented SPECTs. 2
47. Knowlton RC. Can magnetoencephalography aid epilepsy surgery? Epilepsy Curr. 2008;8(1):1-5. Review/Other-Dx N/A Review article to determine whether MEG can help in epilepsy surgery. Evidence exist to support the current use of MEG spike source localization in any patient for whom the question of seizure localization remains after EEG with video recording of habitual seizures and for whom strong clinical suspicion continues for unifocal epilepsy that may be treated surgically. 4
48. Englot DJ, Nagarajan SS, Imber BS, et al. Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery. Epilepsia. 56(6):949-58, 2015 Jun. Observational-Dx 132 patients To determine epileptogenic zone localization using magnetoencephalography to predict seizure freedom in epilepsy surgery.. We studied 132 surgical patients, with mean postoperative follow-up of 3.6 years (minimum 1 year). Dipole source modeling was successful in 103 patients (78%), whereas no interictal spikes were seen in others. Among patients with successful dipole modeling, MEG findings were concordant with and specific to the following: (1) the region of resection in 66% of patients, (2) invasive electrocorticography (ECoG) findings in 67% of individuals, and (3) the magnetic resonance imaging (MRI) abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure-free, this outcome was achieved by only 37% of individuals with MEG findings that were nonspecific to or discordant with the region of resection (?(2) = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp electroencephalography (EEG), and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (95% confidence interval [CI] 2.23-11.8). 2
49. Tovar-Spinoza ZS, Ochi A, Rutka JT, Go C, Otsubo H. The role of magnetoencephalography in epilepsy surgery. Neurosurg Focus 2008;25:E16. Review/Other-Dx N/A To determine the role of magnetoencephalography in epilepsy surgery. No results stated in the abstract. 4
50. Stefan H, Hummel C, Scheler G, et al. Magnetic brain source imaging of focal epileptic activity: a synopsis of 455 cases. Brain 2003;126:2396-405. Review/Other-Dx 455 patients To review the synopsis of 455 epilepsy patients who underwent magnetic brain source imaging of focal epileptic activity investigations. Analysis of this substantial data revealed that the average sensitivity of MEG for specific epileptic activity was 70%. Among 131 patients who underwent surgical therapy in addition to antiepileptic drug medication, MSI identified the lobe to be treated in 89%, with results for extratemporal cases being even superior to those with temporal lobe surgery. Introducing a measure to quantify the contribution of MSI to the general result of presurgical evaluation that was applied to 104 patients, the results showed that MSI supplied additional information in 35% and information crucial to final decision making in 10%. Accuracy as well as contribution findings underlined MSI appropriateness even for extratemporal epilepsies, which otherwise frequently prove difficult with respect to focus localization. 4
51. Singh SP. Magnetoencephalography: Basic principles. Ann Indian Acad Neurol 2014;17:S107-12. Review/Other-Dx N/A To discuss the basic principles of Magnetoencephalography. No results stated in the abstract. 4
52. Szaflarski JP, Gloss D, Binder JR, et al. Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 88(4):395-402, 2017 Jan 24. Meta-analysis 172 articles To assess the diagnostic accuracy and prognostic value of functional MRI (fMRI) in determining lateralization and predicting postsurgical language and memory outcomes. The use of fMRI may be considered an option for lateralizing language functions in place of intracarotid amobarbital procedure (IAP) in patients with medial temporal lobe epilepsy (MTLE; Level C), temporal epilepsy in general (Level C), or extratemporal epilepsy (Level C). For patients with temporal neocortical epilepsy or temporal tumors, the evidence is insufficient (Level U). fMRI may be considered to predict postsurgical language deficits after anterior temporal lobe resection (Level C). The use of fMRI may be considered for lateralizing memory functions in place of IAP in patients with MTLE (Level C) but is of unclear utility in other epilepsy types (Level U). fMRI of verbal memory or language encoding should be considered for predicting verbal memory outcome (Level B). fMRI using nonverbal memory encoding may be considered for predicting visuospatial memory outcomes (Level C). Presurgical fMRI could be an adequate alternative to IAP memory testing for predicting verbal memory outcome (Level C). Clinicians should carefully advise patients of the risks and benefits of fMRI vs IAP during discussions concerning choice of specific modality in each case. Inadequate
53. Janecek JK, Swanson SJ, Sabsevitz DS, et al. Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance. Epilepsia 2013;54:314-22. Observational-Dx 229 patients To more definitively characterize Wada/functional magnetic resonance imaging (fMRI) language dominance discordance rates with the largest sample of patients with epilepsy to date, and to examine demographic, clinical, and methodologic predictors of discordance. Discordant results were observed in 14% of patients. Discordance was highest among those categorized by either test as having bilateral language. In a multivariate model, the only factor that predicted discordance was the degree of atypical language dominance on fMRI. 2
54. Bonelli SB, Thompson PJ, Yogarajah M, et al. Imaging language networks before and after anterior temporal lobe resection: results of a longitudinal fMRI study. Epilepsia. 53(4):639-50, 2012 Apr. Observational-Dx 44 patients To investigate the reorganization of language in left-hemisphere-dominant patients before and after ATLR; whether preoperative functional magnetic resonance imaging (fMRI) predicts postoperative naming decline; and efficiency of postoperative language networks. Postoperatively, individuals with left TLE had greater bilateral middle/inferior frontal fMRI activation and stronger functional connectivity from the left inferior/middle frontal gyri to the contralateral frontal lobe than preoperatively, and this was not observed in individuals with right TLE. Preoperatively, in left and right TLE, better naming correlated with greater preoperative left hippocampal and left frontal activation for verbal fluency (VF). In left TLE, stronger preoperative left middle frontal activation for VF was predictive of greater decline in naming after ATLR. Postoperatively, in left TLE with clinically significant naming decline, greater right middle frontal VF activation correlated with better postoperative naming. In patients without postoperative naming decline, better naming correlated with greater activation in the remaining left posterior hippocampus. In right TLE, naming ability correlated with left hippocampal and left and right frontal VF activation postoperatively. 2
55. Dupont S, Duron E, Samson S, et al. Functional MR imaging or Wada test: which is the better predictor of individual postoperative memory outcome? Radiology 2010;255:128-34. Observational-Dx 25 patients To retrospectively determine whether blood oxygen level-dependent functional magnetic resonance (MR) imaging can aid prediction of postoperative memory changes in epileptic patients after temporal lobe surgery. An equation that was based on left functional MR imaging MTL activation during delayed recognition, side of the epileptic focus, and preoperative global verbal memory score was used to correctly predict worsening of verbal memory in 90% of patients. The right functional MR imaging MTL activation did not substantially correlate with the nonverbal memory outcome, which was only predicted by using the preoperative nonverbal global score. Wada test data were not good predictors of changes in either verbal or nonverbal memory. 2
56. Limotai C, Mirsattari SM. Role of functional MRI in presurgical evaluation of memory function in temporal lobe epilepsy. Epilepsy Res Treat 2012;2012:687219. Review/Other-Dx N/A To review the role of functional MRI in presurgical evaluation of memory function in temporal lobe epilepsy. No results stated in the abstract. 4
57. Jackson GD, Badawy RA. Selecting patients for epilepsy surgery: identifying a structural lesion. [Review]. Epilepsy & Behavior. 20(2):182-9, 2011 Feb. Review/Other-Dx N/A To consider the essential elements of epilepsy and to give a broad overview of what imaging options are available for the investigation of the patient with epilepsy from the perspective of the practicing epileptologist. No results stated in the abstract. 4
58. Tellez-Zenteno JF, Hernandez Ronquillo L, Moien-Afshari F, Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res 2010;89:310-8. Review/Other-Dx 40 articles To provide evidence-based quantitative summary estimates of seizure outcomes in patients with non-lesional and lesional epilepsy treated with surgery, and to assess the consistency of results among published studies. Forty articles fulfilled eligibility criteria and described outcomes in 697 patients with non-lesional epilepsy and 2860 patients with lesional epilepsy. Overall, the odds of being seizurefree after surgery were 2.5 times higher in patients with lesions on MRI or histopathology (OR 2.5, 95%CI 2.1, 3.0, p < 0.001). In patients with temporal lobe epilepsy surgery the odds were 2.7 times higher in those with lesions (OR 2.7, 95%CI 2.1, 3.5, p < 0.001). In patients with extratemporal epilepsy surgery the odds were 2.9 higher in those with lesions (OR 2.9, 95%CI 1.6, 5.1, p < 0.001). Outcomes were similar in children, adults, and studies that used MRI or histopathology to identify lesions. 4
59. Siegel A, Lewis P, Siegel AM. The value of interictal brain SPECT in epilepsy patients without mesial-temporal sclerosis. Clin Nucl Med 2002;27:716-20. Observational-Dx 84 patients To determine the utility of interictal SPECT in patients with neocortical epilipsy. Fifty-four percent of studies with normal MRI findings had SPECT images without regions of hypoperfusion. Sixty-one percent of patients with abnormal MRI results had matching defects visible on SPECT images. Fourteen scans (only 24%) had focal hypoperfusion by SPECT and no obvious matching MRI finding. 3
60. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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