The sensitivity and significance of lateralized interictal slow activity on magnetoencephalography in focal epilepsy
The sensitivity and significance of lateralized interictal slow activity on magnetoencephalography in focal epilepsy
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DOI：
10.1016/j.eplepsyres.2016.01.009
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发表时间：
2016-03-01
影响因子：
2.2
通讯作者：
Kirsch, Heidi E.
中科院分区：
文献类型：
--
作者：
Englot, Dario J.;Nagarajan, Srikantan S.;Kirsch, Heidi E.
目的：癫痫发作间期脑电(EEG)常可观察到不对称的大波幅慢活动。然而，很少有研究研究脑磁图(MEG)记录过程中的减慢，这主要是为了定位发作间拼接。此外，还没有先前的研究比较脑磁图和头皮脑电在检测慢节律方面的敏感性。方法：我们对在我们机构接受脑磁图和手术切除的局灶性癫痫患者进行了一项回顾性队列研究。我们检查了脑磁图、同步脑电和长期脑电记录中显著的不对称慢活动(增量范围，1-4赫兹)，并评估了术后癫痫发作的结果。结果：我们研究了132名术后随访1年(平均3.6年)的患者。平均年龄27岁(范围3-68岁)，55%的患者为男性。发作间期脑磁图上有21例(16%)患者出现不对称的大幅慢波活动。除1例(95%)患者外，所有患者发作间期减慢均偏侧于切除半球。在21例发作间期脑电减慢患者中，11例(52%)有类似偏侧的脑电减慢，7例无脑电减慢，3例有双侧对称性脑电减慢。同时，无偏侧脑磁图减慢的患者中无一例出现不对称性脑电减慢，提示脑磁图对检测非对称性脑电减慢的敏感性显著高于脑电图法(x~(2)=63.4p<；0.001)。脑磁图减慢与癫痫病程缩短有关，优势比为5.4(1.7-17.0，95%可信区间)。在最后一次随访中，92例(70%)患者无癫痫发作(Engel I结局)，有(71%)和无(69%)不对称性脑磁图减慢的患者的发作自由率没有差异(x(2)=0.4，p=0.99)。意义：脑磁图在检测局灶性癫痫不对称慢活动方面比头皮脑电更敏感，这是可靠的偏侧致痫半球。除棘波定位外，脑磁图的其他用途可能会进一步改善癫痫的术前评估。(C)2016爱思唯尔B.V.保留所有权利。
Objective: Asymmetric large-amplitude slow activity is sometimes observed on interictal electroencephalography (EEG) in epilepsy. However, few studies have examined slowing during magnetoencephalography (MEG) recordings, which are performed primarily to localize interictal splices. Also, no prior investigations have compared the sensitivity of MEG to scalp EEG in detecting slow rhythms.Methods: We performed a retrospective cohort study of focal epilepsy patients who received MEG followed by surgical resection at our institution. We examined MEG, simultaneous EEG, and long-term EEG recordings for prominent asymmetric slow activity (delta-range, 1-4 Hz), and evaluated post-operative seizure outcomes.Results: We studied 132 patients with >= 1 year post-operative follow-up (mean, 3.6 years). Mean age was 27 (range, 3-68) years, and 55% of patients were male. Asymmetric large-amplitude slow wave activity was observed on interictal MEG in 21 of 132 (16%) patients. Interictal slowing lateralized to the hemisphere of resection in all but one (95%) patient. Among the 21 patients with interictal MEG slowing, 11 (52%) individuals had similarly lateralized EEG slowing, 7 patients had no EEG slowing, and 3 had bilateral symmetric EEG slowing. Meanwhile, none of the 111 patients without lateralized MEG slowing had asymmetric EEG slowing, suggesting significantly higher sensitivity of MEG versus EEG in detecting asymmetric slowing (chi(2) = 63.4, p < 0.001). MEG slowing was associated with shorter epilepsy duration with an odds ratio of 5.4 (1.7-17.0, 95% confidence interval). At last follow-up, 92 (70%) patients were seizure free (Engel I outcome), with no difference in seizure freedom rates between patients with (71%) or without (69%) asymmetric MEG slowing (chi(2) = 0.4, p = 0.99).Significance: MEG has higher sensitivity than scalp EEG in detecting asymmetric slow activity in focal epilepsy, which reliably lateralizes to the epileptogenic hemisphere. Other uses of MEG beyond spike localization may further improve presurgical evaluations in epilepsy. (C) 2016 Elsevier B.V. All rights reserved.