Knowlton Robert C, Elgavish Rotem, Howell Jennifer, Blount Jeffery, Burneo Jorge G, Faught Edward, Kankirawatana Pongkiat, Riley Kristen, Morawetz Richard, Worthington Julie, Kuzniecky Ruben I
Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham School of Medicine, 35294-0001, USA.
Ann Neurol. 2006 May;59(5):835-42. doi: 10.1002/ana.20857.
Noninvasive brain imaging tests can potentially supplement or even replace the use of intracranial electroencephalogram (ICEEG), an invasive, costly procedure used in presurgical epilepsy evaluation. This study prospectively examined the agreement between magnetic source imaging (MSI) and ICEEG localization in epilepsy surgery candidates.
Patients completing video monitoring with scalp EEG who had intractable partial epilepsy based on ictal electro-clinico-anatomical features were screened. Forty-nine enrolled patients (mean age, 27 years; range, 1-61 years) completed MSI and ICEEG studies. Decisions about ICEEG and surgery were made at a consensus conference where MSI could only influence ICEEG coverage by indicating supplemental coverage to that already planned by an original hypothesis.
The positive predictive value of MSI for seizure localization was 82 to 90%, depending on whether computed against ICEEG alone or in combination with surgical outcome. The kappa score of agreement for MSI with ICEEG was 0.2744 (p < 0.01)
MSI yields localizing information with a high positive predictive value in epilepsy surgery candidates who typically require ICEEG. This finding suggests that enough clinical validity exists for MSI to potentially replace ICEEG for seizure localization.
非侵入性脑成像测试有可能补充甚至取代颅内脑电图（ICEEG）的使用，ICEEG是一种用于术前癫痫评估的侵入性、昂贵的检查方法。本研究前瞻性地检验了癫痫手术候选者中磁源成像（MSI）与ICEEG定位之间的一致性。
筛选出那些根据发作期电临床解剖特征患有难治性部分性癫痫且完成头皮脑电图视频监测的患者。49名入组患者（平均年龄27岁；范围1 - 61岁）完成了MSI和ICEEG检查。关于ICEEG和手术的决策在一次共识会议上做出，在该会议上，MSI只能通过指示对原假设已计划的覆盖范围进行补充覆盖来影响ICEEG的覆盖范围。
MSI对癫痫发作定位的阳性预测值为82%至90%，这取决于计算时是仅对照ICEEG还是结合手术结果。MSI与ICEEG的一致性kappa评分为0.2744（p < 0.01）
在通常需要ICEEG的癫痫手术候选者中，MSI能产生具有高阳性预测值的定位信息。这一发现表明，MSI具有足够的临床有效性，有可能取代ICEEG进行癫痫发作定位。
