Table 8.

Patient Distribution and Description of Defined Resting-State Functional Magnetic Resonance Imaging Epileptogenic Zone “Truth” in Predicting Actual Seizure Freedom Postoperatively

	True condition
Predicted condition	Positive	Negative
Positive	N = 27	N = 7
	True positives	False positives
	rs-fMRI EZ resected, outcome Engel 1 (n = 21) or rs-fMRI EZ resected, and agreed with ic-EEG SOZ, outcome Engel 2–3 (n = 3) or rs-fMRI EZ anatomically separate from ic-EEG, and rs-fMRI EZ not resected, outcome Engel 3–4 (n = 3)	All rs-fMRI EZs resected, agreed with ic-EEG, but outcome <50% seizure reduction and Engel 3, 4 (n = 3) or rs-fMRI EZ not resected, did not agree with ic-EEG, outcome Engel 1–3 (n = 4)
Negative	N = 2	N = 0
	False negatives	True negatives
	rs-fMRI EZ not detected but ic-EEG detected SOZ, outcome Engel 1–3	Neither rs-fMRI EZ nor ic-EEG SOZ detected, outcome Engel 3–4

Sensitivity 93% (95% CI 78–98%). Positive predictive value 79% (95% CI 63–89%). The three children with rs-fMRI EZ and ic-EEG SOZ agreement and resection were considered true positives because the seizure reduction was >90%, with comparatively extremely minimal seizures postoperatively with similar semiology, pointing toward residual tissue from a prior source as the same SOZ driver most likely. In the four patients with a nonresected rs-fMRI separate from the resected ic-EEG SOZ, one was indeterminate, another was a clear false positive, and two were considered true positives. Of these two patients considered true positives, both had long-standing dual seizure semiologies, one of which continued postoperatively, and the other resolved, indicating a separate seizure source clinically.