Dauwels Justin, Eskandar Emad, Cash Sydney
Laboratory for Information and Decision Systems (LIDS), Massachusetts Institute of Technology, Cambridge, MA, USA.
Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:2180-3. doi: 10.1109/IEMBS.2009.5332447.
For as many as 30% of epilepsy patients, seizures are poorly controlled with medication alone. For some of these patients surgery may be an option: the brain region responsible for seizure onset may be removed surgically. However, this requires accurate delineation of the seizure onset region. Currently, the key to making this determination is seizure EEG. Therefore, EEG recordings must continue until enough seizures are obtained to determine the onset region; this may take about 5 days to several weeks. In some cases these recordings must be done using invasive electrodes, a procedure that includes substantial risk, discomfort and cost. In this paper, techniques are developed that use periods of intracranial non-seizure ("rest") EEG to localize epileptogenic networks. Analysis of intracranial EEG (recorded by surface and/or depth electrodes) of 6 epileptic patients shows that certain EEG channels and hence cortical regions are consistently more synchronous ("hypersynchronous") compared to others. It is shown that hypersynchrony seems to strongly correlate with the seizure onset zone; this phenomenon may in the long term allow to determine the seizure onset area(s) from non-seizure EEG, which in turn would enable shorter hospitalizations or even avoidance of semi-chronic implantations all-together.
多达30%的癫痫患者仅通过药物治疗,癫痫发作难以得到有效控制。对于其中一些患者,手术可能是一种选择:可以通过手术切除引发癫痫发作的脑区。然而,这需要精确划定癫痫发作起始区域。目前,做出这一判定的关键是癫痫发作期脑电图。因此,脑电图记录必须持续进行,直到获得足够多的癫痫发作数据以确定起始区域;这可能需要大约5天至几周的时间。在某些情况下,这些记录必须使用侵入性电极进行,该过程存在较大风险、会带来不适且成本较高。在本文中,我们开发了一些技术,利用颅内非癫痫发作(“静息”)期脑电图来定位致痫网络。对6例癫痫患者的颅内脑电图(通过头皮和/或深部电极记录)分析表明,与其他脑电图通道及相应皮质区域相比,某些脑电图通道及相应皮质区域始终表现出更强的同步性(“超同步”)。研究表明,超同步现象似乎与癫痫发作起始区密切相关;从长远来看,这一现象可能有助于从非癫痫发作期脑电图确定癫痫发作起始区域,进而缩短住院时间,甚至完全避免半慢性植入电极。