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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(12): 1274-1281
DOI: 10.1055/s-0042-1758643
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MTL-P300 as a marker of the epileptogenic zone and hippocampal functionality in the presurgical evaluation of temporal lobe epilepsy: a systematic review

MTL-P300 como um marcador da zona epileptogênica e da funcionalidade hipocampal na avaliação pré-operatória da epilepsia do lobo temporal: revisão sistemática
Daniela de Andrade Morange 
1   Université d'Aix-Marseille, Institut de Neurosciences des Systèmes, Marseille, France.
2   Hospital Universitário Prof. Edgard Santos, Serviço de Neurofisiologia Clínica, Salvador BA, Brazil.
,
Martha Silvia Martinez-Silveira 
3   Fundação Oswaldo Cruz (Fiocruz), Instituto Gonçalo Muniz, Salvador BA, Brazil.
,
Magali Teresópolis Reis Amaral 
4   Universidade Estadual de Feira de Santana, Salvador BA, Brazil.
,
Agnès Trebuchon 
1   Université d'Aix-Marseille, Institut de Neurosciences des Systèmes, Marseille, France.
5   Assistance Publique - Hôpitaux de Marseille, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, France.
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Abstract

Background In the past twenty years, there has been an increasing interest among neuroscientists and physicians in mapping the cortical areas involved in the epileptogenic zone (EZ) through event-related potentials (ERPs) that enable the evaluation of the functional preservation of these areas. The present review is an update on publications on this topic.

Objective To investigate the accuracy of the cognitive evoked of the medial temporal lobe P300 (MTL-P300) potential in detecting the EZ in temporal lobe epilepsy (TLE).

Methods The systematic review of articles on the PubMed, Embase and Lilacs databases was conducted between February and December 2020. Articles published in English from 1985 to December 2020 were included. Additional studies were identified by searching the references of the selected studies and review articles. The studies were included for the following reasons: in-depth intracranial electroencephalography (iEEG) analysis of hippocampal activity; investigations of patients with TLE; and correlations between regarding the ERP results obtained in the temporal regions (MTL-P300) and the EZ.

Results In the three studies analyzed, the authors were able to define the laterality of the EZ during the preoperative investigation through the MTL-P300 results. The sensitivity of this method was of ∼ 70% to 80%, and the specificity between 70% and 94.7%. One of the limitations of the present review was the low number of studies.

Conclusion There is evidence that the reduced amplitude of the MTL-P300 has high specificity in identifying the EZ, and this is a good marker for diagnosis in unilateral TLE. The low sensitivity and negative likelihood ratios negative that a normal MTL-P300 response does not exclude the epileptogenicity of the hippocampus.

Resumo

Antecedentes Nos últimos 20 anos, tem havido um crescente interesse de neurocientistas e médicos em mapear áreas corticais envolvidas na zona epileptogênica (ZE) por meio de potenciais relacionados a eventos (PREs), que permitem avaliar a preservação funcional dessas áreas. Esta revisão é uma atualização das publicações sobre esse tema.

Objetivo Investigar a acurácia do potencial evocado cognitivo do lobo temporal medial P300 (medial temporal lobe P300, MTL-P300, em inglês) na detecção da ZE em casos de epilepsias do lobo temporal (ELT).

Métodos A revisão sistemática de artigos nas bases de dados PubMed, Embase e Lilacs foi realizada entre fevereiro e dezembro de 2020. Foram incluídos artigos publicados em inglês de 1985 a dezembro de 2020. Estudos adicionais foram identificados por meio de busca nas referências dos estudos selecionados e artigos de revisão. Os estudos foram incluídos pelas seguintes razões: análise detalhada por meio de eletroencefalografia intracraniana (iEEG) da atividade hipocampal; investigações de pacientes com ELT; e correlações entre os resultados de ERP obtidos nas regiões temporais (MTL-P300) e na ZE.

Resultados Nos três estudos analisados, os autores foram capazes de definir a lateralidade da ZE durante a investigação pré-operatória por meio dos resultados do MTL-P300. A sensibilidade deste método foi de 70% a 80%, e a especificidade, entre 70% e 94.7%. Uma das limitações desta revisão foi o baixo número de estudos.

Conclusão Há evidências de que a amplitude reduzida do MTL-P300 tem alta especificidade na identificação da ZE, e este é um bom marcador para o diagnóstico na ELT unilateral. A baixa sensibilidade e a razão de verossimilhança negativa indicam que a resposta MTL-P300 normal não exclui a epileptogenicidade do hipocampo.

Keywords

Evoked Potentials - Event-Related Potentials, P300 - Epilepsy, Temporal Lobe - Hippocampus

Palavras-chave

Potenciais Evocados - Potencial Evocado P300 - Epilepsia do Lobo Temporal - Hipocampo

Authors' Contributions

DAM: conceived the study idea, designed the methods, collected data, performed the statistical analysis, and drafted the manuscript; MSMS: collected data and reviewed manuscript drafts; AT: collected data and drafted the manuscript; MTRA: discussed the methods, statistical analysis, and results. All authors read, discussed, and approved the final manuscript.




Publication History

Received: 22 September 2021

Accepted: 09 January 2022

Article published online:
29 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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