脑电图-功能磁共振成像技术对局灶性癫痫致痫灶定位的价值

Value of resonance imaging localizing epileptic foci in focal epilepsy

目的探讨在头MRI结构影像阴性的局灶性癫痫患者中，同步脑电图．功能磁共振成像（EEG—fMRI）技术在致痫灶定位诊断中的应用价值。方法选取自2013年4月至2014年7月天津医科大学总医院功能神经外科病房及癫痫专科门诊的头MRI结构影像阴性的局灶性癫痫患者，再进行3．0TEEG-fMRI及头部静息态功能磁共振（RS—fMRI）检查，前者以脑电图中癫痫样放电为事件，经过离线分析得出与放电相关的血氧水平依赖信号（BOLD）反应区。分析每例患者的BOLD激活反应区与电-临床症状定位的关系，以电-临床症状定位作为主要指标分别评判吻合程度。结果共纳入15例患者，其中颞叶癫痫7例；额叶癫痫5例；额颞叶癫痫3例。EEG—fMRI均有与癫痫样放电相关的BOLD信号改变，与电一临床症状定位相比，12例（12／15）基本吻合，3例（3／15）主要部分吻合；15例中3例患者的RS—fMRI有BOLD信号改变，且与电．临床症状学定位基本吻合。EEG-fMRI对BOLD信号的检出率高于RS—fMRI。结论EEG—fMRI检测的与癫痫样放电相关的BOLD反应区可以帮助局灶性癫痫进行非侵入性致痫区定位，为癫痫灶术前评估提供额外的有效信息。

Objective To explore the diagnostic value of simultaneous electroencephalography/ functional magnetic resonance imaging （EEG-fMRI） for epileptic foci in focal epilepsy of normal brain structure. Methods The normal structural images of EEG-fMRI and resting state-fMRI （RS-fMRI） with 3.0T high-field MR system were performed for 15 focal epileptic patients from April 2013 to July 2014. On EEG-fMRI, epileptiform discharges were regarded as nerve stimulation. And off-line analysis yielded the blood oxygen level-dependent （BOLD） responses related to epileptiform discharges. The relationship was analyzed between BOLD activation reaction and electroencephalography-clinical symptomatology position. And the electroencephalography-clinical symptomatology position was selected as a major indicator of judging the degree of concordance. Results The involved lobes were temporal （ n = 7 ）, frontal （ n = 5 ） and frontotemporal （ n = 3 ）. On EEG-fMRI, all patients demonstrated BOLD responses related to epileptiform discharges. Compared with electroeneephalography-clinical symptomatology position, 12 cases （12/15） were fully concordant and 3 cases （3/15） partially concordant. Three patients had BOLD responses in accordance with electreencephalography-elinical symptomatology position on RS-fMRI. And the detection rate of BOLD responses was higher for EEG-fMRI than that for RS-fMRI. Conclusion The BOLD responses related to epileptiform discharges may help locate noninvasively the epileptogenic region of focal epilepsy and provide additional useful information for preoperative evaluations of epilepsy.