High-Density EEG in Current Clinical Practice and Opportunities for the Future.
High-Density EEG in Current Clinical Practice and Opportunities for the Future.
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当前临床实践中的高密度EEG和未来的机遇。
DOI：
10.1097/wnp.0000000000000807
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发表时间：
2021-03-01
期刊：
影响因子：
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通讯作者：
Chu CJ
中科院分区：
文献类型：
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作者：
Stoyell SM;Wilmskoetter J;Dobrota MA;Chinappen DM;Bonilha L;Mintz M;Brinkmann BH;Herman ST;Peters JM;Vulliemoz S;Seeck M;Hämäläinen MS;Chu CJ
高密度脑电图 (HD-EEG) 记录使用比标准 10-20 低密度脑电图 (LD-EEG) 蒙太奇更高的头皮电极空间采样。尽管一些研究已经证明使用 HD-EEG 可以改善致痫皮层的定位，但广泛实施受到成本、设置和解释时间以及缺乏特定或足够的程序计费代码的阻碍。尽管存在这些障碍，HD-EEG 已在多家机构使用多年。这些中心已经注意到在需要提高 HD-EEG 空间分辨率的各种临床场景中的实用性，从而证明额外的时间和成本是合理的。我们利用不同的记录技术和软件分享来自多个中心的精选场景，其中 HD-EEG 提供的信息高于标准 LD-EEG。我们纳入了 HD-EEG 直接对癫痫患者当前临床护理做出贡献的 7 个案例，并重点介绍了两种新技术，这些新技术为改善未来临床护理提供了潜在机会。案例说明了 HD-EEG 如何让临床医生能够： 案例 1）将错误的全身性发作间期癫痫样放电 (IED) 侧化；案例2）改善假性全身性癫痫痉挛的定位；案例 3-4) 改进 IED 在低于标准 LD-EEG 覆盖范围圆周限制的解剖区域中的定位；案例5）改善病变性癫痫发作区的无创定位；案例 6-7) 改善癫痫发作区域的定位，以指导口才皮层附近的侵入性调查；案例8）识别癫痫性快速振荡；案例9）映射语言皮层。这九个案例说明，使用视觉分析和先进技术，HD-EEG 可以在临床管理中发挥重要作用。
High density EEG (HD-EEG) recordings utilize a higher spatial sampling of scalp electrodes than a standard 10–20 low density EEG (LD-EEG) montage. Although several studies have demonstrated improved localization of the epileptogenic cortex using HD-EEG, widespread implementation is impeded by cost, setup and interpretation time, and lack of specific or sufficient procedural billing codes. In spite of these barriers, HD-EEG has been in use at several institutions for years. These centers have noted utility in a variety of clinical scenarios where increased spatial resolution from HD-EEG has been required, justifying the extra time and cost. We share select scenarios from several centers, utilizing different recording techniques and software, where HD-EEG provided information above and beyond the standard LD-EEG. We include seven cases where HD-EEG contributed directly to current clinical care of epilepsy patients and highlight two novel techniques which suggest potential opportunities to improve future clinical care. Cases illustrate how HD-EEG allows clinicians to: Case 1) lateralize falsely generalized interictal epileptiform discharges (IEDs); Case 2) Improve localization of falsely generalized epileptic spasms; Cases 3–4) Improve localization of IEDs in anatomic regions below the circumferential limit of standard LD-EEG coverage; Case 5) Improve non-invasive localization of the seizure onset zone in lesional epilepsy; Cases 6–7) Improve localization of the seizure onset zone to guide invasive investigation near eloquent cortex; Case 8) Identify epileptic fast oscillations; Case 9) Map language cortex. Together, these nine cases illustrate that using both visual analysis and advanced techniques, HD-EEG can play an important role in clinical management.