One-year Experience of Magnetoencephalography at the Nation’s Only Center in Korea: Its Impact on Presurgical Evaluation and Clinical Decision Making in Pediatric Epileptic Surgery
Abstract number :
3.376
Submission category :
5. Neuro Imaging / 5B. Functional Imaging
Year :
2024
Submission ID :
50
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Seok-jin Lee, MD, PhD – Severance Children's Hospital, Yonsei University College of Medicine
Soyoung Jang, MD – Department of Pediatric Neurology, Severance Children’s Hospital, Yonsei University College of Medicine
Hui Jin Shin, MD – Department of Pediatric Neurology, Severance Children’s Hospital, Yonsei University College of Medicine
Se Hee Kim, MD-PhD – Severance Children's Hospital, Yonsei University College of Medicine
Hoon-Chul Kang, MD-PhD – Severance Children's Hospital, Yonsei University College of Medicine
Joon Soo Lee, MD-PhD – Severance Children's Hospital, Yonsei University College of Medicine
Ara Ko, MD-PhD – Severance Children's Hospital, Yonsei University College of Medicine
Rationale: The nation’s one and only Magenetoencephalography (MEG) center opened at Severance Hospital, Seoul, Korea on March 1, 2023. Since its inauguration, 59 cases of pediatric epilepsy at Severance Hospital included MEG as part of routine presurgical evaluation. Unfortunate past experience of the shut-down of the first MEG center in 2017 put pressure on validating the utility and contribution of MEG for pediatric epilepsy patients in Korea. Maintaining a stable and sustainable operating environment as the nation’s only MEG center requires continued governmental support. Here we evaluated how the incorporation of MEG has changed and impacted the presurgical evaluation and decision-making process since its opening in March, 2023.
Methods: A retrospective chart review was conducted for pediatric epilepsy patients who underwent presurgical evaluation with MEG included. We delineated the clinical course of all 59 patients after the presurgical evaluation. We categorized each case according to whether or not the epilepsy surgery plan was affected by the results of MEG findings, reasons for a change in a surgery plan, the type of surgery performed, the concordance of MEG findings with other evaluations, additional information provided by MEG, and eventual clinical course of the patients.
Results: Among 59 cases of presurgical evaluation, MEG provided additional information in 21 cases (36%) while no additional information thus concordant with other evaluations such as EEG recordings, Brain MRI, PET, SPECT was obtained in 38 cases (64%). Of those cases where MEG provided additional information, the value of information contributed to the change of surgery plan in 15 cases (25% of total 59 cases). Notably, in 3 cases, the precise localization of surgical target sites by MEG dipoles allowed improvement in surgical planning. In 11 cases, the presence of MEG dipoles in bilateral hemispheres thus overall discordance in the lateralization of epileptogenic zone resulted in not proceeding with resective surgery but pursuing other options such as corpus callosotomy or vagal nerve stimulator implantation for epilepsy management. We provide a flow chart demonstrating the clinical course of our patients following presurgical evaluation (Figure 1). The results of detailed analysis will be presented during a poster session.
Conclusions: Since the incorporation of MEG as part of routine presurgical evaluation for pediatric epilepsy patients, clinical decision making in 25% of the cases have been affected by the results of MEG strongly suggesting that the interpretation of MEG findings along with those of other modalities have become indispensable component of the presurgical evaluation at our epilepsy center.
Funding: No external funding was recieved.
Neuro Imaging