Stefan H, Hummel C, Scheler G, Genow A, Druschky K, Tilz C, Kaltenhäuser M, Hopfengärtner R, Buchfelder M, Romstöck J
Department of Neurology, Epilepsy Center, University of Erlangen-Nuernberg, Germany.
Brain. 2003 Nov;126(Pt 11):2396-405. doi: 10.1093/brain/awg239. Epub 2003 Jul 22.
Epilepsy surgery is based upon the minute assessment of brain tissue generating epileptic activity. A number of diagnostic methods are employed in the process of presurgical evaluation, supplying information on various morphological and functional aspects, ultimately integrated into the general result fundamental to the final treatment decision. Magnetic source imaging (MSI), combining structural (MRI) and functional (MEG) data, has been playing an increasingly important role among the tools of presurgical epilepsy evaluation. However, in spite of a considerable number of publications, the samples used have hardly exceeded 50 cases. Therefore, we present a synopsis of 455 epilepsy patients who underwent MSI investigations. Analysis of this substantial data revealed that the average sensitivity of MEG for specific epileptic activity was 70%. Among 131 patients who underwent surgical therapy in addition to antiepileptic drug medication, MSI identified the lobe to be treated in 89%, with results for extratemporal cases being even superior to those with temporal lobe surgery. Introducing a measure to quantify the contribution of MSI to the general result of presurgical evaluation that was applied to 104 patients, the results showed that MSI supplied additional information in 35% and information crucial to final decision making in 10%. Accuracy as well as contribution findings underlined MSI appropriateness even for extratemporal epilepsies, which otherwise frequently prove difficult with respect to focus localization.
癫痫手术基于对产生癫痫活动的脑组织进行的细致评估。在术前评估过程中采用了多种诊断方法，这些方法提供了有关各种形态学和功能方面的信息，最终整合到对最终治疗决策至关重要的总体结果中。磁源成像（MSI）结合了结构（MRI）和功能（MEG）数据，在术前癫痫评估工具中发挥着越来越重要的作用。然而，尽管有大量的出版物，但所使用的样本几乎没有超过50例。因此，我们总结了455例接受MSI检查的癫痫患者的情况。对这些大量数据的分析表明，MEG对特定癫痫活动的平均敏感性为70%。在131例除抗癫痫药物治疗外还接受手术治疗的患者中，MSI确定了89%的待治疗脑叶，颞叶外病例的结果甚至优于颞叶手术病例。引入一种量化MSI对术前评估总体结果贡献的方法，并将其应用于104例患者，结果显示MSI在35%的患者中提供了额外信息，在10%的患者中提供了对最终决策至关重要的信息。准确性以及贡献结果强调了MSI即使对于颞叶外癫痫也适用，否则颞叶外癫痫在病灶定位方面常常很困难。
