Holmes Mark D, Brown Micah, Tucker Don M, Saneto Russell P, Miller Kai J, Wig Gagan S, Ojemann Jeffrey G
Department of Neurology, University of Washington, Seattle, WA 98105, USA.
Pediatr Neurosurg. 2008;44(6):474-9. doi: 10.1159/000180302. Epub 2008 Dec 10.
A 13-year-old girl presented with refractory seizures since the age of 5 years. Clinical exam and MRI studies were normal. Ictal EEG discharges suggested possible left posterior quadrant distribution but were not well localized with standard methods. A seizure was recorded during 128-channel EEG video long-term monitoring prior to invasive recordings. Applying a source analysis method, seizure onset and propagation patterns were calculated and displayed on an MRI model. The onset was localized to the left inferior posterior occipital cortex, followed by propagation to the right, then left, posterior cerebral hemispheres, and finally to the left superior-medial parietal lobe. These patterns were replicated closely on subsequent invasive recordings. Surgery was based on intracranial findings and she is seizure-free 30 months after resection. Noninvasive dense-array EEG, used in conjunction with realistic source analysis methods, may have the potential to assist in localizing seizure onsets when standard methods fail.
一名13岁女孩自5岁起就出现难治性癫痫发作。临床检查和磁共振成像（MRI）研究均正常。发作期脑电图放电提示可能呈左后象限分布，但用标准方法未能很好地定位。在进行侵入性记录之前，通过128导脑电图视频长期监测记录到一次癫痫发作。应用源分析方法，计算癫痫发作起始和传播模式，并显示在MRI模型上。发作起始定位于左枕叶后下部皮质，随后传播至右侧，然后是左侧大脑后半球，最后至左上内侧顶叶。这些模式在随后的侵入性记录中得到了密切重现。手术基于颅内检查结果，切除术后30个月她已无癫痫发作。当标准方法失效时，结合现实源分析方法使用的非侵入性密集阵列脑电图可能有助于癫痫发作起始的定位。
