Stereoelectroencephalography in presurgical assessment of MRI-negative epilepsy

Stereoelectroencephalography in presurgical assessment of MRI-negative epilepsy
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DOI：
10.1093/brain/awm218
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发表时间：
2007-12-01
期刊：
BRAIN
影响因子：
14.5
通讯作者：
Chauvel, Patrick
Chauvel, Patrick
中科院分区：
医学1区
文献类型：
--
作者：
McGonigal, Aileen;Bartolomei, Fabrice;Chauvel, Patrick

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根据现有的大多数文献，在癫痫切除手术中，缺乏MRI病变通常与较差的预后相关。通常需要通过颅内记录来描绘致痫区域(EZ)，但在MRI阴性的病例中被认为更困难。以前的大多数研究都使用硬膜下记录，而关于立体脑电信号(SEEG)的公开数据相对较少。这项研究的目的是报告我们小组在术前评估中使用SEEG的经验，比较其在正常和病变MRI病例中的有效性。对100名连续接受SEEG术前评估的患者进行了研究。在100名患者中，43名(43名)MRI正常，57名(57名)有病变MRI。MRI正常组41/43(95例)和病变组55/57(96例)定位成功，两组间无明显差异(P=1.00)。有84/100的患者建议手术，16/100的患者禁忌症，在皮损和MRI阴性组之间没有显著差异(P&gt；0.05)。在1年的随访中，MRI阴性组中接受皮质切除术的患者中有11/20(55)和病变MRI组中的21/40(53)完全没有癫痫发作(P&gt；0.05)，这一比例在2年的随访中保持不变。90例癫痫发作控制有显著改善(ILAE结果组14例)，组间无差异(P&gT；0.05)。在接受手术的MRI阴性病例中，10/23(43)例局灶性皮质发育不良。这一系列研究表明，SEEG在MRI阴性癫痫和损伤性癫痫的术前评估中同样有效。
According to most existing literature, the absence of an MRI lesion is generally associated with poorer prognosis in resective epilepsy surgery. Delineation of the epileptogenic zone (EZ) by intracranial recording is usually required but is perceived to be more difficult in MRI negative cases. Most previous studies have used subdural recording and there is relatively less published data on stereoelectroencephalography (SEEG). The objective of this study was to report the experience of our group in using SEEG in presurgical evaluation, comparing its effectiveness in normal and lesional MRI cases. One hundred consecutive patients undergoing SEEG for presurgical assessment were studied. Forty-three patients out of one hundred (43) had normal MRI and 57 (57) had lesional MRI. Successful localization was achieved with no difference between these two groups, in 41/43 (95) normal MRI and in 55/57 (96) lesional MRI cases (P = 1.00). Surgery was proposed in 84/100 patients and contraindicated in 16/100 with no significant difference between lesional and MRI-negative groups (P > 0.05). At 1 year follow-up, 11/20 (55) of those having undergone cortectomy in the MRI-negative group and 21/40 (53) in the lesional MRI group were entirely seizure free (P > 0.05) and these proportions were maintained at 2 years follow-up. Significant improvement in seizure control (ILAE outcome groups 14) was achieved in >90 cases with no difference between groups (P > 0.05). Of MRI-negative cases that underwent surgery, 10/23 (43) had focal cortical dysplasia. This series showed that SEEG was equally effective in the presurgical evaluation of MRI-negative and lesional epilepsies.