Combined Electroencephalography-Functional Magnetic Resonance Imaging and Electrical Source Imaging Improves Localization of Pediatric Focal Epilepsy
Combined Electroencephalography-Functional Magnetic Resonance Imaging and Electrical Source Imaging Improves Localization of Pediatric Focal Epilepsy
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DOI：
10.1002/ana.25003
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发表时间：
2017-08-01
影响因子：
11.2
通讯作者：
Carmichael, David W.
中科院分区：
文献类型：
--
作者：
Centeno, Maria;Tierney, Tim M.;Carmichael, David W.
目的：正确定位致痫灶是外科治疗癫痫的有效方法。在这里，我们使用同步脑电图功能磁共振成像（EEG-fMRI）的数据，以获得EEG-fMRI和电源成像（ESI）地图。他们的产量和他们的个人和联合能力（1）本地化的EZ和（2）预测癫痫发作outcome.Methods：53名儿童与耐药性癫痫进行了脑电图功能磁共振成像。使用EEG-fMRI血流动力学反应和ESI绘制发作间期放电。从每个单独的测试（EEG-fMRI全局最大值[GM]/ESI最大值）和两个图的组合（EEG-fMRI/ESI空间交叉）中得出单个定位。为了确定定位的准确性和预测性能，个人和联合测试定位进行了比较，以假定的EZ和postsurgical outcome.Results：五十二个53例患者有显着的地图：47的53脑电图功能磁共振成像，44的53 ESI，和34的53为两者。29例患者的EZ特征良好; 26例患者的EEG-fMRI GM定位正确，11例患者的定位正确，22例患者的ESI定位正确，17例患者的定位正确，12例患者的EEG-fMRI和ESI联合定位正确，11例患者的定位正确。切除术后癫痫发作的结果是正确预测的脑电图功能磁共振成像GM在8 20例患者中，和ESI最大值在13 16。联合EEG-fMRI/ESI区域完全预测9例患者的结果，包括3例在MRI上没有可见病变的患者，解释：EEG-fMRI结合ESI提供了一个简单的无偏定位，可能比每个单独的测试更好地预测手术，包括MRI阴性患者。
Objective: Surgical treatment in epilepsy is effective if the epileptogenic zone (EZ) can be correctly localized and characterized. Here we use simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) data to derive EEG-fMRI and electrical source imaging (ESI) maps. Their yield and their individual and combined ability to (1) localize the EZ and (2) predict seizure outcome were then evaluated.Methods: Fifty-three children with drug-resistant epilepsy underwent EEG-fMRI. Interictal discharges were mapped using both EEG-fMRI hemodynamic responses and ESI. A single localization was derived from each individual test (EEG-fMRI global maxima [GM]/ESI maximum) and from the combination of both maps (EEG-fMRI/ESI spatial intersection). To determine the localization accuracy and its predictive performance, the individual and combined test localizations were compared to the presumed EZ and to the postsurgical outcome.Results: Fifty-two of 53 patients had significant maps: 47 of 53 for EEG-fMRI, 44 of 53 for ESI, and 34 of 53 for both. The EZ was well characterized in 29 patients; 26 had an EEG-fMRI GM localization that was correct in 11, 22 patients had ESI localization that was correct in 17, and 12 patients had combined EEG-fMRI and ESI that was correct in 11. Seizure outcome following resection was correctly predicted by EEG-fMRI GM in 8 of 20 patients, and by the ESI maximum in 13 of 16. The combined EEG-fMRI/ESI region entirely predicted outcome in 9 of 9 patients, including 3 with no lesion visible on MRI.Interpretation: EEG-fMRI combined with ESI provides a simple unbiased localization that may predict surgery better than each individual test, including in MRI-negative patients.