Magnetic source imaging and ictal SPECT in MRI-negative neocortical epilepsies: Additional value and comparison with intracranial EEG
Magnetic source imaging and ictal SPECT in MRI-negative neocortical epilepsies: Additional value and comparison with intracranial EEG
复制标题
DOI：
10.1111/epi.12004
复制
发表时间：
2013-02-01
期刊：
影响因子：
5.6
通讯作者：
Burgess, Richard C.
中科院分区：
文献类型：
--
作者：
Schneider, Felix;Wang, Z. Irene;Burgess, Richard C.
目的：探讨磁源成像 (MSI) 和发作期单光子发射计算机断层扫描 (SPECT) 与颅内脑电图 (EEG) (ICEEG) 的效用，以定位非病变新皮质局灶性癫痫患者的致痫区 (EZ) 并预测癫痫手术结果。方法：对 14 名连续的非病变性新皮质癫痫患者进行研究，这些患者接受了术前评估，包括 ICEEG、阳性 MSI 和与 MRI (SISCOM) 分析同步的定位减影 Ictal SPECT。癫痫手术后随访24个月。 ICEEG、MSI 和 SPECT 结果使用亚肺叶分类进行分类。主要发现：14 名患者中，6 名（42.9%）在手术后癫痫发作消失。 11 名患者的亚肺叶 ICEEG 病灶被完全切除；其中 5 人（45.5%）不再癫痫发作。 5 名（35.7%）患者的 ICEEG 和 MSI 一致且病灶完全切除；其中 80% 的患者不再癫痫发作。亚肺叶 ICEEG-MSI 一致性和完全病灶切除显着增加了癫痫手术后无癫痫发作的机会 (p=0.038)。相比之下，在 ICEEG 和 SISCOM 一致且病灶完全切除的 6 名患者 (42.9%) 中，只有 66.7% 的患者无癫痫发作 (p=0.138)。假设结果一致，与 ICEEG-SISCOM（优势比 6）相比，ICEEG-MSI（优势比 14）单独对 ICEEG 定位 EZ 的附加价值更高。意义：本研究表明，MSI 和/或 SISCOM 与 ICEEG 相结合可用于非病变性新皮质癫痫患者的术前评估。 MSI 或 SISCOM 与 ICEEG 的一致测试结果为 ICEEG 单独提供的测试结果提供了有用的附加信息，以在这一最具挑战性的患者群体中定位 EZ。当观察到亚肺叶与 ICEEG 的一致性时，与 SISCOM 相比，MSI 在预测无癫痫发作的癫痫手术结果方面更有优势。
Purpose: To investigate the utility of magnetic source imaging (MSI) and ictal single photon emission computed tomography (SPECT), each compared with intracranial electroencephalography (EEG) (ICEEG), to localize the epileptogenic zone (EZ) and predict epilepsy surgery outcome in patients with nonlesional neocortical focal epilepsy. Methods: Studied were 14 consecutive patients with nonlesional neocortical epilepsy who underwent presurgical evaluation including ICEEG, positive MSI, and localizing subtraction Ictal SPECT coregistered to MRI (SISCOM) analysis. Follow-up after epilepsy surgery was 24 months. ICEEG, MSI, and SPECT results were classified using a sublobar classification. Key Findings: Of 14 patients, 6 (42.9%) became seizure-free after surgery. Sublobar ICEEG focus was completely resected in 11 patients; 5 (45.5%) of them became seizure- free. Concordance of ICEEG and MSI and complete focus resection was found in 5 (35.7%) patients; 80% of them became seizure-free. Sublobar ICEEG-MSI concordance and complete focus resection significantly increased the chance of seizure freedom after epilepsy surgery (p=0.038). In contrast, of the 6 patients (42.9%) with concordant ICEEG and SISCOM and complete focus resection, only 66.7% became seizure-free (p=0.138). Assuming concordant results, the additive value to ICEEG alone for localizing the EZ is higher with ICEEG-MSI (odds ratio14) compared to ICEEG-SISCOM (odds ratio6). Significance: This study shows that combination of MSI and/or SISCOM with ICEEG is useful in the presurgical evaluation of patients with nonlesional neocortical epilepsy. Concordant test results of either MSI or SISCOM with ICEEG provide useful additive information for that provided by ICEEG alone to localize the EZ in this most challenging group of patients. When sublobar concordance with ICEEG is observed, MSI is more advantageous compared to SISCOM in predicting seizure-free epilepsy surgery outcome.