Preoperative evaluation using magnetoencephalography: Experience in 382 epilepsy patients
Preoperative evaluation using magnetoencephalography: Experience in 382 epilepsy patients
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DOI：
10.1016/j.eplepsyres.2016.05.002
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发表时间：
2016-08-01
影响因子：
2.2
通讯作者：
Hillebrand, A.
中科院分区：
文献类型：
--
作者：
Nissen, I. A.;Stam, C. J.;Hillebrand, A.
目的：确定癫痫患者的临床脑磁图可能是有益的，避免或优化繁琐的辅助调查。我们确定它是否可以预测前期，如果MEG将能够产生一个假设的位置的致痫区（EZ），在患者MEG未能做到这一点。方法：MEG记录382例癫痫患者的不确定的结果，关于EZ定位之前MEG被收购术前评估。根据人口统计学、临床和MEG变量对MEG报告进行分类。首先，人口统计学和临床变量与MEG定位能力相关。其次，所有变量进行了比较，患者与无MEG位置，以表征患者无MEG location.Results：我们的患者组往往有复杂的病因，并不包含（通过其他手段）简单和本地化的情况下，如那些与一致的肿瘤和EEG位置。对于我们高度选择的患者组，MEG定位能力不能预先预测，尽管在没有肿瘤和存在广泛MRI异常的情况下，MEG位置记录的几率显著更高。与有MEG定位的患者相比，无MEG定位的患者更常出现肿瘤、广泛EEG异常、非偏侧MEG异常、不一致MEG/EEG异常，而较少出现广泛MRI异常或癫痫样MEG活动。在一个亚组的48例患者已知的手术结果，更多的患者与一致的MEG和切除面积的perforure-free比患者不一致的results.Conclusions：MEG可能会增加信息的位置EZ，即使在患者具有复杂的病因，和临床建议是不扣留MEG癫痫手术候选人。对于EEG和MRI结果不确定的患者，以及缺乏特异性癫痫样活动的患者，使用MEG提供关于EZ位置的假设是困难的。对于MEG目前无法支持EZ位置假设的患者，需要更精确的方法。(c)2016爱思唯尔B. V.保留所有权利。
Objective: Identifying epilepsy patients for whom clinical MEG is likely to be beneficial avoids or optimizes burdensome ancillary investigations. We determined whether it could be predicted upfront if MEG would be able to generate a hypothesis about the location of the epileptogenic zone (EZ), and in which patients MEG fails to do so.Methods: MEG recordings of 382 epilepsy patients with inconclusive findings regarding EZ localization prior to MEG were acquired for preoperative evaluation. MEG reports were categorized for several demographic, clinical and MEG variables. First, demographic and clinical variables were associated with MEG localization ability for upfront prediction. Second, all variables were compared between patients with and without MEG location in order to characterize patients without MEG location.Results: Our patient group had often complex etiology and did not contain the (by other means) straightforward and well-localized cases, such as those with concordant tumor and EEG location. For our highly-selected patient group, MEG localization ability cannot be predicted upfront, although the odds of a recording with MEG location were significantly higher in the absence of a tumor and in the presence of widespread MRI abnormalities. Compared to the patients with MEG location, patients without MEG location more often had a tumor, widespread EEG abnormalities, non-lateralizing MEG abnormalities, non-concordant MEG/EEG abnormalities and less often widespread MRI abnormalities or epileptiform MEG activity. In a subgroup of 48 patients with known surgery outcome, more patients with concordant MEG and resection area were seizure-free than patients with discordant results.Conclusions: MEG potentially adds information about the location of the EZ even in patients with a complex etiology, and the clinical advice is to not withhold MEG in epilepsy surgery candidates. Providing a hypothesis about the location of the EZ using MEG is difficult in patients with inconclusive EEG and MRI findings, and in the absence of specific epileptiform activity. More refined methods are needed for patients where MEG currently does not contribute to the hypothesis about the location of the EZ. (c) 2016 Elsevier B.V. All rights reserved.