• Reinaldo Uribe San Martin, Roberta Di Giacomo, Roberto Mai, Francesca Gozzo, Veronica Pelliccia, Valeria Mariani, Francesco Cardinale, Ethel Ciampi, Marco Onofrj, and Laura Tassi.
• Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile.
• Neurosurgery. 2020 Dec 15; 88 (1): 113-121.

BackgroundAccurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery.ObjectiveTo evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy.MethodsWe selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed.ResultsA total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients.ConclusionThe degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.Copyright © 2020 by the Congress of Neurological Surgeons.

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