EEG和MEG在额叶癫痫致痫灶定位的价值

The value of electroencephalography and magnetoencephalography in the localization of epileptic foci of frontal lobe epilepsy

目的:评估脑电图(EEG)和脑磁图(MEG)在难治性额叶癫痫(FLE)致痫灶定位的价值,以提高术前定位的准确性。方法:16例FLE患者,根据临床发作表现、发作间期和发作期EEG、MRI、PET-CT的检查结果进行综合评估后致痫灶定位仍困难,再行MEG检查。其中9例行手术治疗,术中皮层脑电图(ECoG)和/或深部电极脑电图(DEEG)监测并验证术前定位的准确性。结果:本组发作表现、EEG、MRI、PET-CT能准确定位的比率分别为:18.75%、31.25%、25%、43.75%;MEG棘波源定位优于EEG,可局限在脑回水平;EEG记录的痫性波范围比MEG广,但棘波优势区与MEG结果一致;术中ECoG和/或DEEG监测结果证实MEG定位的准确性。结论:MEG是一种能准确定位FLE致痫灶的术前无创性检查技术,与EEG检查相结合,可全面反映FLE的电生理状态,为外科手术治疗提供帮助。

Objective： To analyze electroen cephalography （EEG） and magnetoencephalography （MEG） of refractory frontal lobe epilepsy, and obtain accurate localization of epileptic loci before operation. Meth. ods： 16 patients with frontal lobe epilepsy （FLE） who have difficulties in the localization of epileptic foci with clinical features, interictal and ictal EEG, MRI, PET-CT, received interictal MEG examination. 9 of the 16 cases received surgical operation and the accuracy of localization in MEG was confirmed by intracranial electrical record during operation. Results： The positive predictive value of clinical features of epileptic seizure, interictal and ietal EEG, MRI and PET-CT, respectively were 18.75%, 31.25%, 25%, 43.75%. MEG source localization was better at localization than EEG. EEG recording epileptic discharge was more extensive than MEG. The accuracy localization of MEG was confirmed by intracranial electrical monitoring during operation. Conclusion： MEG is a noninvasive technique used for the accurate epileptic loci localization in pre-surgieal epilepsy evaluation. MEG combined with EEG will reflex panorama of neurological electrophysiology in FLE.