Investigation for human cortical epilepsy network using functional and anatomical analyses

这项研究的主要目的是可视化“致痫网络”，以指导对药物难治性新皮质癫痫进行适当的皮质切除。在我们的新皮质癫痫手术病例中，我们结合多种电生理学分析方法，如皮层脑电地形图分析的新方法和皮质诱发电位，研究了癫痫活动的皮质传播和扩散。我们还调查了通过多种方式获得的结果之间的一致性，并试图建立可靠的术前评估方法来改善手术结果。我们仍在继续研究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，我们发现我们可以根据术前脑磁图结果的类型来对新皮质癫痫患者的致痫和难治性进行分类。其次，在与癫痫相关的肿瘤病变患者中，我们发现可以通过术中ECoG数据的地形图分析来划分需要切除的区域。第三，在颞叶癫痫患者中，我们通过皮质诱发电位证实了内侧颞叶结构和颞叶新皮质之间癫痫相关网络的存在。我们这项研究的最终策略是将我们对大脑皮层之间联系的结果与高质量磁共振轴突成像的结果结合起来，以可视化患者的“癫痫网络”。由于技术上的限制，我们不可能达到这方面的目标。这项研究仍在进行中，以改进这些局限性，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.