Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery.
Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery.
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作者：
Englot DJ;Nagarajan SS;Imber BS;Raygor KP;Honma SM;Mizuiri D;Mantle M;Knowlton RC;Kirsch HE;Chang EF
癫痫手术的疗效关键取决于成功定位致痫区。脑磁图（MEG）能够非侵入性地检测癫痫的间期峰活动，然后可以使用磁源成像（MSI）技术在三维空间中定位。然而，MEG在术前癫痫评估中的临床价值尚不完全清楚，因为迄今为止的研究受到缺乏长期癫痫发作结果或样本量小的限制。我们对局灶性癫痫患者进行了回顾性队列研究，这些患者在我们的机构接受了MEG进行间期尖峰定位，然后进行了手术切除。我们研究了132例手术患者，平均术后随访3.6年（最少1年）。偶极源建模在103例（78%）患者中成功，而在其他患者中未见间期尖峰。在成功建立偶极子模型的患者中，MEG结果与：(1)66%患者的切除区域一致，(2)67%个体的侵入性皮质电图（ECoG）结果一致，(3)74%病例的MRI异常。脑磁图显示约5%的病例侧化不一致。手术后，70%的患者实现了癫痫发作的自由（Engel I级结果）。尽管85%具有一致和特异性MEG结果的患者无癫痫发作，但只有37%具有非特异性或与切除区域不一致MEG结果的患者实现了这一结果（χ2 = 26.4, p < 0.001）。在有或没有定位头皮脑电图的患者中，MEG的可靠性相当，总体而言，定位MEG结果预测癫痫发作自由的比值比为5.11 （2.23-11.8,95% CI）。在癫痫手术中，MEG是一种有价值的非侵入性间期尖峰定位工具，包括长期脑电图监测中发现非定位的患者，使用MEG定位癫痫区与改善癫痫发作结果相关。
The efficacy of epilepsy surgery depends critically upon successful localization of the epileptogenic zone. Magnetoencephalography (MEG) enables non-invasive detection of interictal spike activity in epilepsy, which can then be localized in three dimensions using magnetic source imaging (MSI) techniques. However, the clinical value of MEG in the pre-surgical epilepsy evaluation is not fully understood, as studies to date are limited by either a lack of long-term seizure outcomes or small sample size. We performed a retrospective cohort study of focal epilepsy patients who received MEG for interictal spike mapping followed by surgical resection at our institution. We studied 132 surgical patients, with mean post-operative follow-up of 3.6 years (minimum 1 year). Dipole source modelling was successful in 103 (78%) patients, while no interictal spikes were seen in others. Among patients with successful dipole modelling, MEG findings were concordant with and specific to: i) the region of resection in 66% of patients, ii) invasive electrocorticography (ECoG) findings in 67% of individuals, and iii) the MRI abnormality in 74% of cases. MEG showed discordant lateralization in ~5% of cases. After surgery, 70% of all patients achieved seizure-freedom (Engel class I outcome). Whereas 85% of patients with concordant and specific MEG findings became seizure-free, this outcome was achieved by only 37% of individuals with MEG findings that were non-specific or discordant with the region of resection (χ2 = 26.4, p < 0.001). MEG reliability was comparable in patients with or without localized scalp EEG, and overall, localizing MEG findings predicted seizure freedom with an odds ratio of 5.11 (2.23–11.8, 95% CI). MEG is a valuable tool for non-invasive interictal spike mapping in epilepsy surgery, including patients with non-localized findings on long-term EEG monitoring, and localization of the epileptogenic zone using MEG is associated with improved seizure outcomes.
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与局灶性新皮质癫痫手术失败有关的因素。
影响因子：
4.8
作者：
Englot DJ;Raygor KP;Molinaro AM;Garcia PA;Knowlton RC;Auguste KI;Chang EF
通讯作者：
Chang EF
影响因子：
14.5
作者：
Agirre-Arrizubieta, Z.;Huiskamp, G. J. M.;Leijten, F. S. S.
通讯作者：
Leijten, F. S. S.
影响因子：
11.2
作者：
Knowlton, Robert C.;Razdan, Shantanu N.;Limdi, Nita;Elgavish, Rotem A.;Killen, Jeff;Blount, Jeffrey;Burneo, Jorge G.;Hoef, Lawrence Ver;Paige, Lebron;Faught, Edward;Kankirawatana, Pongkiat;Bartolucci, Al;Riley, Kristen;Kuzniecky, Ruben
通讯作者：
Kuzniecky, Ruben
影响因子：
5.6
作者：
Cascino, Gregory D.
通讯作者：
Cascino, Gregory D.
影响因子：
2.2
作者：
Kim, Hyunmi;Kankirawatana, Pongkiat;Knowlton, Robert
通讯作者：
Knowlton, Robert