Influence of magnetic source imaging for planning intracranial EEG in epilepsy
Influence of magnetic source imaging for planning intracranial EEG in epilepsy
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DOI：
10.1212/01.wnl.0000326591.29858.1a
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发表时间：
2008-09-23
期刊：
影响因子：
9.9
通讯作者：
Lopez, N.
中科院分区：
文献类型：
--
作者：
Sutherling, W. W.;Mamelak, A. N.;Lopez, N.
背景：磁源成像(MSI)被常规用于癫痫的术前评估和定位手术所需的大脑皮质。尽管MSI的使用越来越多，但其诊断效率仍不确定，报告的范围从5%到35%不等。为了增加益处，诊断技术应该影响其他测试的决定，这种影响应该产生更好的结果。我们报告了一项正在进行的癫痫长期临床研究的初步结果，其中MSI改变了手术决定。方法：我们在前瞻性、盲法、交叉对照、单一治疗、观察性病例系列中确定MSI是否改变了手术决定。69名被诊断为疑似新皮质起源的部分性癫痫的序贯患者进行了视频脑电和成像。所有患者均符合颅内脑电图(ICEEG)标准。在一次外科会议上，在提出MSI之前和之后做出了决定。结果：MSI在23例(33%)患者中提供了非冗余信息。MSI增加ICEEG电极9例(13%)，改变手术决定14例(20%)。根据MSI，16名患者(23%)被安排在不同的ICEEG覆盖范围内。28人接受了ICEEG，29人接受了切除，14人接受了迷走神经刺激，其中17人的MSI改变了决定。4例患者附加电极覆盖正确部位：半球3例，叶3例，叶下发作区1例。2例MSI避开对侧电极，均定位于ICEEG。结论：磁源成像(MSI)在33%的患者中提供了非冗余信息。到目前为止，在那些接受过手术的患者中，MSI增加了有用的信息，改变了6例(9%)的治疗，而没有增加并发症。MSI使21%的接受手术的人受益。
Background: Magnetic source imaging (MSI) is used routinely in epilepsy presurgical evaluation and in mapping eloquent cortex for surgery. Despite increasing use, the diagnostic yield of MSI is uncertain, with reports varying from 5% to 35%. To add benefit, a diagnostic technique should influence decisions made from other tests, and that influence should yield better outcomes. We report preliminary results of an ongoing, long-term clinical study in epilepsy, where MSI changed surgical decisions.Methods: We determined whether MSI changed the surgical decision in a prospective, blinded, crossover-controlled, single-treatment, observational case series. Sixty-nine sequential patients diagnosed with partial epilepsy of suspected neocortical origin had video-EEG and imaging. All met criteria for intracranial EEG (ICEEG). At a surgical conference, a decision was made before and after presentation of MSI. Cases where MSI altered the decision were noted.Results: MSI gave nonredundant information in 23 patients (33%). MSI added ICEEG electrodes in 9 (13%) and changed the surgical decision in another 14 (20%). Based on MSI, 16 patients (23%) were scheduled for different ICEEG coverage. Twenty-eight have gone to ICEEG, 29 to resection, and 14 to vagal nerve stimulation, including 17 where MSI changed the decision. Additional electrodes in 4 patients covered the correct: hemisphere in 3, lobe in 3, and sublobar ictal onset zone in 1. MSI avoided contralateral electrodes in 2, who both localized on ICEEG. MSI added information to ICEEG in 1.Conclusion: Magnetic source imaging (MSI) provided nonredundant information in 33% of patients. In those who have undergone surgery to date, MSI added useful information that changed treatment in 6 (9%), without increasing complications. MSI has benefited 21% who have gone to surgery.