Krakow Karsten
Department of Neurology, J.W. Goethe University, and Brain Imaging Center, Frankfurt, Germany.
Neurodegener Dis. 2008;5(5):286-95. doi: 10.1159/000135613. Epub 2008 Jun 3.
This review concentrates on functional MRI (fMRI) methods to identify the epileptic focus, i.e. ictal and interictal fMRI. First, established clinical applications of fMRI in the field of epilepsy are briefly introduced: fMRI of sensorimotor, language and memory function can already be considered as clinically relevant tools to identify the eloquent cortex and to predict postoperative functional deficits in patients considered for epilepsy surgery. fMRI offers a valid alternative to invasive methods like the Wada test for establishing language dominance, and it is likely that it will also replace the Wada test for assessing presurgical memory function in the nearer future. Ictal fMRI (fMRI studies of epileptic seizures) will remain confined to exceptional cases due to practical limitations. The generators of interictal epileptiform discharges (IED) can be studied with EEG-correlated fMRI. Despite its technical challenges, it has proved useful to provide insights into the generation of IED in patients with focal and generalized epilepsy. In selected patients with focal IED, EEG-correlated fMRI has the potential to reproducibly identify cortical areas involved in generating IED, i.e. the irritative zone. In patients with generalizes IED, suspension of functional networks due to the IED can be demonstrated. The utility of EEG-correlated fMRI in clinical epileptology cannot be definitely determined yet.
本综述聚焦于功能磁共振成像（fMRI）方法以识别癫痫病灶，即发作期和发作间期fMRI。首先，简要介绍fMRI在癫痫领域已确立的临床应用：感觉运动、语言和记忆功能的fMRI已可被视为识别明确皮层以及预测癫痫手术患者术后功能缺损的临床相关工具。fMRI为确定语言优势的侵入性方法（如Wada试验）提供了一种有效的替代方法，并且在不久的将来它也很可能会取代Wada试验用于评估术前记忆功能。由于实际限制，发作期fMRI（癫痫发作的fMRI研究）将仍局限于特殊病例。发作间期癫痫样放电（IED）的起源可通过与脑电图相关的fMRI进行研究。尽管存在技术挑战，但已证明其有助于深入了解局灶性和全身性癫痫患者IED的产生。在选定的局灶性IED患者中，与脑电图相关的fMRI有可能可重复地识别参与产生IED的皮层区域，即刺激区。在全身性IED患者中，可以证明由于IED导致的功能网络中断。与脑电图相关的fMRI在临床癫痫学中的效用尚未能明确确定。
