UCSF Epilepsy Center, Department of Neurology, USA.
Clin Neurophysiol. 2010 Mar;121(3):325-31. doi: 10.1016/j.clinph.2009.12.001. Epub 2010 Jan 12.
To evaluate the ability of MEG to detect medial temporal spikes in patients with known medial temporal lobe epilepsy (MTLE) and to use magnetic source imaging (MSI) with equivalent current dipoles to examine localization and orientation of spikes and their relation to surgical outcome.
We prospectively obtained MSI on a total of 25 patients previously diagnosed with intractable MTLE. MEG was recorded with a 275 channel whole-head system with simultaneous 21-channel scalp EEG during inpatient admission one day prior to surgical resection. The patients' surgical outcomes were classified based on one-year follow-up after surgery.
Nineteen of the 22 patients (86.4%) had interictal spikes during the EEG and MEG recordings. Thirteen of 19 patients (68.4%) demonstrated unilateral temporal dipoles ipsilateral to the site of surgery. Among these patients, five (38.5%) patients had horizontal dipoles, one (7.7%) patient had vertical dipoles, and seven (53.8%) patients had both horizontal and vertical dipoles. Sixty percent of patients with non-localizing ictal scalp EEG had well-localized spikes on MSI ipsilateral to the side of surgery and 66.7% of patients with non-localizing MRI had well-localized spikes on MSI ipsilateral to the side of surgery. Concordance between MSI localization and the side of lobectomy was not associated with a likelihood of an excellent postsurgical outcome.
MSI can detect medial temporal spikes. It may provide important localizing information in patients with MTLE, especially when MRI and/or ictal scalp EEG are not localizing.
This study demonstrates that MSI has a good ability to detect interictal spikes from mesial temporal structures.
评估 MEG 检测已知内侧颞叶癫痫（MTLE）患者内侧颞部棘波的能力，并使用等效电流偶极子的磁源成像（MSI）检查棘波的定位和方向及其与手术结果的关系。
我们前瞻性地对 25 名先前被诊断为难治性 MTLE 的患者进行了 MSI 检查。MEG 是在手术切除前一天住院期间使用 275 通道全头系统和同时进行的 21 通道头皮 EEG 记录的。根据术后一年的随访情况对患者的手术结果进行分类。
在 EEG 和 MEG 记录中，22 例患者中有 19 例（86.4%）出现了发作间期棘波。19 例患者中有 13 例（68.4%）显示手术部位同侧颞叶偶极子单侧。在这些患者中，5 例（38.5%）患者的偶极子为水平，1 例（7.7%）患者的偶极子为垂直，7 例（53.8%）患者的偶极子既有水平也有垂直。60%的发作性头皮 EEG 无定位的患者在手术同侧的 MSI 上有定位良好的棘波，66.7%的 MRI 无定位的患者在手术同侧的 MSI 上有定位良好的棘波。MSI 定位与侧别切除术之间的一致性与术后良好结局的可能性无关。
MSI 可以检测到内侧颞部棘波。它可能为 MTLE 患者提供重要的定位信息，特别是在 MRI 和/或发作性头皮 EEG 无定位时。
本研究表明，MSI 具有良好的检测内侧颞叶结构发作间期棘波的能力。
