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A systematic review and meta-analysis (PRISMA; 1990–2025) identified MRI-neg cohorts and used unsupervised clustering to stratify imaging-modality co-occurrence while evaluating MRI reporting consistency, rater expertise, post-processing, and SEEG effects on diagnostic yield and post-surgical outcomes.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/mri-negative-epilepsy-a-systematic-review-and-meta-analysis/452802/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/mri-negative-epilepsy-a-systematic-review-and-meta-analysis/452802.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"Why is the MRI-negative designation considered ambiguous in drug-resistant focal epilepsy?","Question",{"text":112,"@type":113},"The criteria used to assign MRI-neg status vary across studies, with many lacking details on imaging parameters and reader expertise, leading to inconsistent labeling.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What databases and time span were used in the systematic review?",{"text":117,"@type":113},"The review followed PRISMA guidance and searched Embase, Cochrane, and Medline databases across 1990–2025 to identify cohorts with MRI-neg epilepsy.",{"name":119,"@type":110,"acceptedAnswer":120},"How did post-processing affect diagnostic yield for MRI-negative epilepsy?",{"text":121,"@type":113},"Meta-analyses showed a 39% gain in diagnostic yield after post-processing, with a reported 95% confidence interval.",{"name":123,"@type":110,"acceptedAnswer":124},"What were the outcome differences between MRI-positive and MRI-negative patients?",{"text":125,"@type":113},"Compared with MRI-pos patients, MRI-neg patients underwent SEEG more frequently but surgery less frequently and had less favorable outcomes, while the proportion of favorable surgical outcome was higher in MRI-pos than in MRI-neg.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},452802,1791039511,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":143,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":149,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","DOI: 10.1111/epi.18616  \nRESEAR CH ARTICLE  \nMRI-negative epilepsy: A systematic review and meta-analysis  \nRavnoor S. Gill1 | Francesco Deleo2  | Boris Bernhardt3 | Samuel Wiebe4  | Neda Bernasconi1  | Andrea Bernasconi1   \n1Neuroimaging of Epilepsy Laboratory and Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada  \n2Istituto Neurologico Carlo Besta, Milan, Italy  \n3Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute, McGill University, Montreal, Canada 4Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada  \nCorrespondence  \nAndrea Bernasconi, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada. [Email:](Email: andrea.bernasconi@mcgill.ca)[ andrea.bernasconi@mcgill.ca](Email: andrea.bernasconi@mcgill.ca)  \nFunding information  \nNatural Sciences and Engineering Research Council of Canada, Grant/Award Number: NSERC;  \nDiscovery-243141 and NSERC;  \nDiscovery-24779; Epilepsy Canada; Brain Canada; Fonds de Recherche du Québec-Santé  \nAbstract  \nObjective: Drug-resistant focal epilepsy is commonly dichotomized based on magnetic resonance imaging (MRI) lesion visibility into positive (MRI-pos) and negative (MRI-neg). Yet, the criteria used to ascribe such categorization are variable. We used a systematic review and meta-analysis to synthesize evidence for the designation of MRI-neg status.  \nMethods: In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the systematic review (1990–2025) across Embase, Cochrane, and Medline databases identified cohorts with MRIneg epilepsy. Unsupervised clustering stratified studies based on co-occurrence of imaging modalities. Within identified classes, we assessed the consistency of reporting MRI parameters, rater expertise, post-processing, and stereo–electroencephalography (SEEG). Meta-analyses evaluated the effects of post-processing on diagnostic yield and MRI-neg status on post-surgical outcome.  \nResults: We screened 2622 records and assessed the eligibility of 448 full-text articles, 246 of which met the inclusion criteria for systematic review: 108 (44%) provided data only on MRI-neg and 138 (56%) on mixed adult cohorts, for a total of 10.463 MRI-neg and 7436 MRI-pos patients. Compared to MRI-pos, MRI-neg patients underwent SEEG more frequently (75% vs 54%, p \u003C0.05), underwent surgery less frequently (73% vs 84%; odds ratio [OR] = 1.14, p \u003C0.001), and had less favorable outcomes (61% vs 72%, p \u003C0.05). Clustering identified three classes: MRI-dominant, typified by consistent reporting of MRI parameters (ORs >3.11, p \u003C0.001), rater-expertise (ORs >9.94, p \u003C0.001), and post-processing (ORs >3.38, p \u003C0 .03), as opposed to Limited-MRI (χ2 = 41.08, p \u003C0 .001); MRI-and-nuclearimaging class was typified by use of SEEG (ORs >3.33, p\u003C0.02) . Meta-analyses showed a 39% gain in diagnostic yield after post-processing (11.10, 95% confidence interval [CI] 7.45–16.53) and a higher proportion of favorable surgical outcome in MRI-pos compared to MRI-neg (75% vs 58%; χ2 = 19. 10, p\u003C0 .001) . Time-based sensitivity analyses did not affect results.  \nNeda Bernasconi and Andrea Bernasconi contributed equally to this work.  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.  \n© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.  \nSignificance: The designation of MRI-neg is ambiguous, with most studies lacking details on imaging parameters and reader expertise. Given a 39% gain in diagnostic yield, MRI post-processing should be performed systemati","cbCaidG0DvW5RYZu","https://ap.wps.com/l/cbCaidG0DvW5RYZu","pdf",2607387,11,"English","# Abstract\n## Objective\n## Methods\n## Results\n## Significance\n# Introduction","[{\"question\":\"Why is the MRI-negative designation considered ambiguous in drug-resistant focal epilepsy?\",\"answer\":\"The criteria used to assign MRI-neg status vary across studies, with many lacking details on imaging parameters and reader expertise, leading to inconsistent labeling.\"},{\"question\":\"What databases and time span were used in the systematic review?\",\"answer\":\"The review followed PRISMA guidance and searched Embase, Cochrane, and Medline databases across 1990–2025 to identify cohorts with MRI-neg epilepsy.\"},{\"question\":\"How did post-processing affect diagnostic yield for MRI-negative epilepsy?\",\"answer\":\"Meta-analyses showed a 39% gain in diagnostic yield after post-processing, with a reported 95% confidence interval.\"},{\"question\":\"What were the outcome differences between MRI-positive and MRI-negative patients?\",\"answer\":\"Compared with MRI-pos patients, MRI-neg patients underwent SEEG more frequently but surgery less frequently and had less favorable outcomes, while the proportion of favorable surgical outcome was higher in MRI-pos than in MRI-neg.\"}]","MRI-negative epilepsy - A systematic review and meta-analysis | PDF",1790737716,28]