MTL-P300 as a marker of the epileptogenic zone and hippocampal functionality in the presurgical evaluation of temporal lobe epilepsy: a systematic review

Morange, Daniela de Andrade; Martinez-Silveira, Martha Silvia; Amaral, Magali Teresópolis Reis; Trebuchon, Agnès

doi:10.1055/s-0042-1758643

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View and Review • Arq. Neuro-Psiquiatr. 80 (12) • 2022 • https://doi.org/10.1055/s-0042-1758643 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

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

Authors/year	Criteria^* * 1: Criteria for inclusion in the sample defined; 2: subjects and the setting described; 3: exposure measured in a valid way; 4: standard criteria to measure the condition; 5: confounding factors identified; 6: strategies to deal with confounding factors stated; 7: outcomes measured in a valid way; 8: appropriate statistical analysis.
Authors/year	1	2	3	4	5	6	7	8	Total
Puce et al., 1989⁷7 Puce A, Kalnins RM, Berkovic SF, Donnan GA, Bladin PF. Limbic P3 potentials, seizure localization, and surgical pathology in temporal lobe epilepsy. Ann Neurol 1989;26(03):377–385. Doi: 10.1002/ana.410260311 https://doi.org/10.1002/ana.410260311...	Y	Y	Y	Y	N	N	Y	Y	6
Meador et al., 1992²⁰20 Meador KJ, Loring DW, Gallagher BB, et al. Differential effects of left versus right seizure focus on human hippocampal evoked responses. Int J Neurosci 1992;66(1-2):87–91. Doi: 10.3109/00207459208999792 https://doi.org/10.3109/0020745920899979...	Y	U	Y	Y	N	N	Y	Y	5
Grunwald et al., 1995¹⁹19 Grunwald T, Elger CE, Lehnertz K, Van Roost D, Heinze HJ. Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy. Electroencephalogr Clin Neurophysiol 1995;95 (01):53–62. Doi: 10.1016/0013-4694(95)00015-Q https://doi.org/10.1016/0013-4694(95)000...	Y	Y	Y	Y	NA	NA	Y	Y	6

Author and year	Study design	Population	Intracranial electroencephalography method	Oddball task
Puce et al., 1989⁷7 Puce A, Kalnins RM, Berkovic SF, Donnan GA, Bladin PF. Limbic P3 potentials, seizure localization, and surgical pathology in temporal lobe epilepsy. Ann Neurol 1989;26(03):377–385. Doi: 10.1002/ana.410260311 https://doi.org/10.1002/ana.410260311...	Cross-sectional study	57 patients	Bilateral depth electrodes were implanted stereotaxically in the hippocampi via an orthogonal approach	Auditory oddball paradigm
Meador et al., 1992²⁰20 Meador KJ, Loring DW, Gallagher BB, et al. Differential effects of left versus right seizure focus on human hippocampal evoked responses. Int J Neurosci 1992;66(1-2):87–91. Doi: 10.3109/00207459208999792 https://doi.org/10.3109/0020745920899979...	Cross-sectional study	30 patients	Bilateral depth electrodes placed stereotaxically via a vertex trajectory to traverse the hippocampi	Auditory oddball paradigm
Grunwald et al., 1995¹⁹19 Grunwald T, Elger CE, Lehnertz K, Van Roost D, Heinze HJ. Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy. Electroencephalogr Clin Neurophysiol 1995;95 (01):53–62. Doi: 10.1016/0013-4694(95)00015-Q https://doi.org/10.1016/0013-4694(95)000...	Cross-sectional study	25 patients	Bilateral depth electrodes implanted stereotaxically along the longitudinal axis of the hippocampus	Visual oddball paradigm

Authors	Outcome measures	Results
Puce et al., 1989⁷7 Puce A, Kalnins RM, Berkovic SF, Donnan GA, Bladin PF. Limbic P3 potentials, seizure localization, and surgical pathology in temporal lobe epilepsy. Ann Neurol 1989;26(03):377–385. Doi: 10.1002/ana.410260311 https://doi.org/10.1002/ana.410260311...	The ratio of the lowest amplitude of hippocampal MTL-P300 to the largest	Bilaterally absent MTL-P300 only in 7% of the patients; it is not a useful marker to ward off bitemporal epilepsies.
		Sensitivity of abnormal MTL-P300 responses of 81% and specificity of 94,7%; LR+ of 15.3 and LR- of 0.20
Meador et al., 1992²⁰20 Meador KJ, Loring DW, Gallagher BB, et al. Differential effects of left versus right seizure focus on human hippocampal evoked responses. Int J Neurosci 1992;66(1-2):87–91. Doi: 10.3109/00207459208999792 https://doi.org/10.3109/0020745920899979...	Calculation of the sum of the entire power spectrum (0–30 Hz) on the right and left sides during the target stimulus	Lower sensitivity in left TLE than in right TLE. Sensitivity of abnormal MTL-P300 responses of 70% and specificity of 70%; LR+ of 2.3 and LR- of 0.43.
Grunwald et al., 1995¹⁹19 Grunwald T, Elger CE, Lehnertz K, Van Roost D, Heinze HJ. Alterations of intrahippocampal cognitive potentials in temporal lobe epilepsy. Electroencephalogr Clin Neurophysiol 1995;95 (01):53–62. Doi: 10.1016/0013-4694(95)00015-Q https://doi.org/10.1016/0013-4694(95)000...	Subtracting (the amplitude of the MTL-P300 on the left minus the amplitude on the right)	The sensitivity of the MTL-P300 was not significant to diagnose EZ laterality in patients without hippocampal sclerosis.
		Sensitivity of abnormal MTL-P300 responses of 80% and specificity of 80%; LR+ of 4.0 and LR- of 0.25.

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[1] Address for correspondence Daniela de Andrade Morange (e-mail: danielaandrade71@hotmail.com).