脑磁图对病灶性新皮质癫癎术前评估的价值

Interictal magnetoencephalographic findings related with surgical outcomes in lesional neocortical epilepsy

目的研究病灶性新皮质癫癎发作间期MEG和MRI一致性与预后的关系。方法 23例病灶性新皮质癫癎接受了术前评估及手术治疗,所有患者术前均接受MEG检测,数据分析处理采用等价电流偶极子(ECD)法和合成孔径法(SAMg2)。7例患者接受了颅内电极植入后长程视频皮层脑电图监测。术后随访一年以上并运用Engel法评价预后。结果 MEG与MRI一致的病例手术有效率(Engel class I or Ⅱ)及术后无发作率(Engel class IA)均优于不一致者。结论病灶性新皮质癫癎,MEG结果与MRI结果一致时手术效果良好,对此类病例不需要再进行颅内电极植入行癫癎灶定位,颅内电极植入仅适用于MEG结果与MRI结果不一致的病例或需要功能区定位者。

Objective To investigate whether interictal magnetoencephalography （MEG） concordant with MRI findings could predict surgical outcome in patients with lesional refractory neocortical epilepsy（NE）. Methods 23 patients with lesional NE were studied. MEG was recorded for all patients and Synthetic aperture magnetometry （SAM） with excess kurtosis （g2） and conventional Equivalent Current Dipole （ECD） were used for MEG data analysis. 7 patients had a long-term extraoperative intracranial video electroeneephalography （iVEEG） monitoring. Surgical outcomes were assessed based on over one-year follow-up after surgery using Engel classification system. Results Both favorable outcomes （Engel class I or II ） and seizure freedom outcomes （Engel class IA） were higher for the concordance condition （MEG findings are concordant with MRI） versus the discordance condition. Conclusions This study demonstrates that a favorable postsurgical outcome can be obtained in most patients with concordant MEG and MRI results even without extraoperative ivEEG monitoring, extraoperative iVEEG monitoring seems to be unnecessary to those patients ,but it remains prerequisite to the patients with discordant MEG and MRI findings or to those needing eloquent areas mapping.