The relationship between morphological lesion, magnetic source imaging, and intracranial stereo-electroencephalography in focal cortical dysplasia.
The relationship between morphological lesion, magnetic source imaging, and intracranial stereo-electroencephalography in focal cortical dysplasia.
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DOI：
10.1016/j.nicl.2017.04.018
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Jung J
中科院分区：
文献类型：
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作者：
Bouet R;Mauguière F;Daligault S;Isnard J;Guenot M;Bertrand O;Jung J
脑磁图（MEG）是一种有用的非侵入性技术，用于局灶性皮质发育不良患者的术前评估。我们的目的是明确脑磁图测定的峰值体积、癫痫发作区和局灶性皮质发育不良患者的病变体积之间的精确空间关系。我们研究了11例局灶性皮质发育不良患者的脑磁共振成像（MRI）显示的病变体积与最近的分析管道测定的脑磁图峰值体积、由颅内脑电图信号计算的定量指数（“致痫性指数”）确定的癫痫发作区位置之间的空间关系。8/11例患者脑磁峰活动与致痫性指数有显著相关性。7/8例患者接受手术治疗，手术效果良好。3例患者的致痫性指数与尖峰活动无相关性；3例患者中仅有1例手术效果良好。在8/9的患者中，病变至少部分与癫痫发作区重叠，MRI可以清楚地识别病变。然而，57%的SEEG致痫性接触位于病变体积之外。最后，44%的高致痫性SEEG接触点位于峰值体积内，22%的接触点仅位于峰值体积而不在病变内。对于7/9的病变患者，< 50%的癫痫性SEEG接触包括在病变内；对于5/7的患者，MEG为通过颅内电极靶向癫痫区域提供了附加价值，而对于7名患者中的2名，MEG仅检测到少量外伤性癫痫接触。我们的研究表明，在局灶性皮质发育不良患者中，脑磁图的峰值体积建模是一种很有前途的非侵入性癫痫发作区定位工具。结合脑MRI，脑磁图对峰值体积的建模有助于描绘癫痫发作区的空间范围。本研究探讨局灶性皮质发育不良（FCD）患者癫痫发作灶、病变与脑磁图峰值之间的关系。FCD患者的病变、癫痫发作区和脑磁图峰值体积在很大程度上是同宽的脑区。MEG有助于揭示远离病变的致痫区。MEG是对MRI的补充，用于估计FCD患者SOZ的完整程度。
Magnetoencephalography (MEG) is a useful non-invasive technique for presurgical evaluation of focal cortical dysplasia patients. We aimed at clarifying the precise spatial relationship between the spiking volume determined with MEG, the seizure onset zone and the lesional volume in patients with focal cortical dysplasia. We studied the spatial relationships between the MEG spiking volume determined with a recent analysis pipeline, the seizure-onset zone location determined with a quantitative index calculated from intracranial EEG signals (‘Epileptogenicity Index’) and the lesional volume delineated on brain MRI in 11 patients with Focal Cortical Dysplasia explored with Stereo-electroencephalography (SEEG). A significant correlation between the MEG spiking activity and the Epileptogenicity Index was found in 8/11 patients. 7/8 patients were operated upon and had good surgical outcome. For three patients, no correlation between Epileptogenicity Index and spiking activity was observed; only one of those three patients had good surgical outcome. The lesion was at least partially overlapping with the seizure-onset zone in 8/9 patients with a lesion clearly identifiable by MRI. However, 57% of the SEEG epileptogenic contacts were located outside of the lesional volume. Lastly 44% of the highly epileptogenic SEEG contacts were located within the spiking volume and 22% of them were located exclusively in the spiking volume and not in the lesion. For 7/9 patients with a lesion, < 50% of epileptogenic SEEG contacts were included within the lesion: for 5/7 patients MEG provided an added value for targeting the epileptogenic region through intracranial electrodes, while for two of seven patients MEG detected only a few extralesional epileptogenic contacts. Our study suggests that modeling of the spiking volume with MEG is a promising tool to localize non-invasively the seizure-onset zone in patients with focal cortical dysplasia. Combined with brain MRI, MEG modeling of the spiking volume contributes to delineate the spatial extent of the seizure-onset zone. This study investigates the relationship between the seizure focus, the lesion and the MEG spikes in Focal Cortical Dysplasia (FCD). The lesion, the seizure-onset zone and the MEG spiking volumes in FCD patients are largely co-extensive brain regions. MEG is helpful to disclose epileptogenic areas remote from the lesion. MEG is complementary to MRI to estimate the full extent of the SOZ in patients with FCD.