Optimising EEG-fMRI for Localisation of Focal Epilepsy in Children.
Optimising EEG-fMRI for Localisation of Focal Epilepsy in Children.
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DOI：
10.1371/journal.pone.0149048
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Carmichael DW
中科院分区：
文献类型：
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作者：
Centeno M;Tierney TM;Perani S;Shamshiri EA;StPier K;Wilkinson C;Konn D;Banks T;Vulliemoz S;Lemieux L;Pressler RM;Clark CA;Cross JH;Carmichael DW
对耐药癫痫患儿进行早期手术干预有好处，但需要使用可耐受的微创试验。脑电图-功能磁共振成像研究表明，对癫痫病灶定位的敏感性很好，但产量很低，尽管其原因尚未得到系统的解决。而成人EEG-fMRI研究是在“静息状态”下进行的；儿童通常使用镇静剂，然而，这有相关的风险和潜在的混淆。在本研究中，我们评估了以下因素对儿童EEG-fMRI耐受性和结果的影响：在扫描仪内观看电影；运动;癫痫样间歇放电（IED）的发生；扫描时间和设计效率。这项工作的动机是优化脑电图-功能磁共振成像参数，使这项测试广泛适用于儿科人群46例局灶性癫痫患儿和20例对照组（6-18岁）进行了脑电图-功能磁共振成像。在两个10分钟的疗程中，受试者被要求闭着眼睛躺着不动，就像在成人研究中通常进行的那样（“休息疗程”），在另外两个疗程中，受试者观看儿童友好的刺激，即电影（“电影疗程”）。用脑电图-功能磁共振成像（EEG-fMRI）对每个疗程和跨疗程的IED进行映射。所得到的图谱被分类为与每个受试者假定的致痫灶一致/不一致。移动随着扫描时间的延长而增加，但在前20分钟播放时，移动会减少约40%。电影对IED的发生没有影响，也不符合试验。在20分钟和40分钟的扫描时间内，EEG-fMRI绘制癫痫发生区域的能力相似。设计效率可预测一致性。儿童友好的自然刺激提高了脑电图-功能磁共振成像的耐受性，减少了扫描仪内的运动，而不会影响IED的发生和脑电图-功能磁共振成像图的质量。这使我们能够扫描6岁的儿童，并在没有镇静的情况下获得定位信息。我们的数据表明，在频繁发生IED的儿童中，~20分钟是扫描EEG-fMRI的最佳时间。自发IED产生的fMRI设计效率是产生一致结果的重要因素。
Early surgical intervention in children with drug resistant epilepsy has benefits but requires using tolerable and minimally invasive tests. EEG-fMRI studies have demonstrated good sensitivity for the localization of epileptic focus but a poor yield although the reasons for this have not been systematically addressed. While adults EEG-fMRI studies are performed in the “resting state”; children are commonly sedated however, this has associated risks and potential confounds. In this study, we assessed the impact of the following factors on the tolerability and results of EEG-fMRI in children: viewing a movie inside the scanner; movement; occurrence of interictal epileptiform discharges (IED); scan duration and design efficiency. This work’s motivation is to optimize EEG-fMRI parameters to make this test widely available to paediatric population Forty-six children with focal epilepsy and 20 controls (6–18) underwent EEG-fMRI. For two 10 minutes sessions subjects were told to lie still with eyes closed, as it is classically performed in adult studies (“rest sessions”), for another two sessions, subjects watched a child friendly stimulation i.e. movie (“movie sessions”). IED were mapped with EEG-fMRI for each session and across sessions. The resulting maps were classified as concordant/discordant with the presumed epileptogenic focus for each subject. Movement increased with scan duration, but the movie reduced movement by ~40% when played within the first 20 minutes. There was no effect of movie on the occurrence of IED, nor in the concordance of the test. Ability of EEG-fMRI to map the epileptogenic region was similar for the 20 and 40 minute scan durations. Design efficiency was predictive of concordance. A child friendly natural stimulus improves the tolerability of EEG-fMRI and reduces in-scanner movement without having an effect on IED occurrence and quality of EEG-fMRI maps. This allowed us to scan children as young as 6 and obtain localising information without sedation. Our data suggest that ~20 minutes is the optimal length of scanning for EEG-fMRI studies in children with frequent IED. The efficiency of the fMRI design derived from spontaneous IED generation is an important factor for producing concordant results.