Investigation for human cortical epilepsy network using functional and anatomical analyses

本研究的主要目的是可视化的“癫痫网络”，这将指导适当的皮质切除药物难治性新皮质癫痫。在我们的新皮层癫痫手术病例中，我们通过结合各种电生理分析（如ECoG的MEG地形图分析的新分析方法和皮层-皮层诱发电位）研究了癫痫活动的皮层传播和扩散。我们也研究了多种方式获得的结果之间的差异，并试图建立可靠的术前评估方法，以提高手术效果。我们仍在进行术前评估和术后癫痫发作结果之间的相关性。到目前为止，我们得出了几个结论。首先，我们发现我们可以通过术前脑磁图的结果来对患者的新皮质癫痫的致痫性和难治性进行分类。第二，在癫痫相关肿瘤病灶的患者中，我们发现我们可以通过术中ECoG数据的地形图分析来划定要切除的区域。第三，在颞叶癫痫患者中，我们通过皮层-皮层诱发电位证实了内侧颞叶结构和颞叶新皮层之间存在癫痫相关网络。本研究的最终策略是将我们的皮质连接结果与高质量MR轴向成像结果结合联合收割机，以可视化患者的“癫痫网络”。由于技术上的限制，我们未能达到这方面的目标。本研究仍在进行中，以改善这种局限性，并建立新的诊断方法。

The primary purpose of this study was to visualize "the epileptogenic network", which guide the appropriate cortical resection for medically intractable neocortical epilepsy. We investigated the cortical propagation and spreading of epileptic activities by combination of various electrophysiological analyses such as the new analytic method for MEG topographic analysis of ECoG, and cortico-cortical evoked potentials, in our surgical cases of neocortical epilepsy. We have also investigated consistencies among results obtained by multiple modalities and have attempted to establish the reliable preoperative evaluation method to improve surgical outcomes. We are still proceeding to correlate between the presurgical evaluations and postsurgical seizure outcomes. We achieved several conclusions so far. First, we found we can classify the epileptogenicity and intractability of patients' neocortical epilepsy by patterns of presurgical MEG results. Second, in patients with tumor lesion relating to epilepsy, we found we can demarcate the areas to be resected by topographic analysis of intraoperative ECoG data. Third, in patients with temporal lobe epilepsy, we confirm the existence of the epilepsy related network between the medial temporal structure and temporal neocortices by cortico-cortical evoked potentials. Our final strategy of this study was to combine our results of connections between cortices and results of the high-quality MR axonography, to visualize the patient's "epilepsy network". Due to the technical limitations, we could not have achieved at the goal in this respect. This study is still ongoing to improve such limitations and to establish the new diagnostic methods.