Clinical relevance of source location in frontal lobe epilepsy and prediction of postoperative long-term outcome
Clinical relevance of source location in frontal lobe epilepsy and prediction of postoperative long-term outcome
复制标题
DOI：
10.1016/j.seizure.2014.04.006
复制
发表时间：
2014-08-01
影响因子：
3
通讯作者：
Stefan, Hermann
中科院分区：
文献类型：
--
作者：
Mu, Jie;Rampp, Stefan;Stefan, Hermann
目的：目的：探讨脑磁图（MEG）源定位在额叶癫痫（FLE）定位中的价值。方法：回顾性分析46例（28例男性）经MEG术前评估和难治性FLE手术患者的临床资料，平均随访5年。磁偶极子分析用于MEG源成像（MSI）。分析了偶极子簇相对于优势半球、病变、切除腔和功能皮质的定位。结果：发作间期局灶性癫痫活动发生率为82.6%（38/46），其中单灶性癫痫活动发生率为81.6%（31/38），多灶性癫痫活动发生率为18.4%（7/38）。平均随访5.0 +/- 4.0年（中位数11.5，范围2-57）时，无癫痫发作率为47.9%。癫痫复发主要发生在术后1年内。在单灶性癫痫活动组中，58.1%（18/31）的患者无癫痫发作，预测术后无癫痫发作优于多灶定位0%（0/7）（p = 0.028）。在70.9%的单灶性活动患者中，偶极子簇被完全切除，与部分切除相比，其无癫痫发作率更高（p = 0.002）。在优势半球手术的患者中，癫痫控制的可能性较小（p = 0.006）。结论：MSI有助于FLE患者术后结局的临床预测。MSI可以无创性地发现早期致痫灶，提示可切除病灶，从而为术前评估提供了捷径。(C)2014年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: To evaluate the value of magnetoencephalography (MEG) source localization in localization of epileptic activities and predicting surgical outcome in frontal lobe epilepsies (FLE).Methods: Forty-six patients with presurgical MEG evaluation and intractable FLE surgery (28 male patients) were analyzed retrospectively with a mean follow-up of 5 years. Dipole analysis was performed for MEG source imaging (MSI). The localization of dipole clusters in relation to the dominant hemisphere, lesions, resection cavity and functional cortex were analyzed. The predictive value of MSI in respect to clinical outcome with long-term postoperative follow up was evaluated.Results: Interictal focal epileptic activities were found in 82.6% (38/46) patients with monofocal activity 81.6% (31/38) and multifocal activities 18.4% (7/38). Seizure free rate was 47.9% at the mean follow-up of 5.0 +/- 4.0 years (median 11.5, range 2-57). Seizure recurrence mainly occurred in the first 1 year after surgery. In the monofocal epileptic activity group, 58.1% (18/31) of the patients were seizure free, predicitng postoperative seizure freedom better than multifocal localization 0% (0/7) (p = 0.028). Dipole clusters were completely resected in 70.9% of monofocal activity patients, which had higher seizure free rates compared to partial resection (p = 0.002). In patients with surgery in the dominant hemisphere, seizure control was less likely (p = 0.006).Conclusion: MSI contributes to the clinical prediction of postoperative outcome in FLE patients. MSI may non-invasively disclose early epileptogenic lesions, pointing to a resectable lesion, and it then facilitates shortcut route of presurgical evaluation. (C) 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.