Regional Epilepsy Center, Department of Neurology, University of Washington, Seattle, Washington 98104, USA.
Neurosurgery. 2010 Feb;66(2):354-62. doi: 10.1227/01.NEU.0000363721.06177.07.
To compare the localization of the seizure onset zone estimated from ictal recordings with high spatial resolution, 256-channel scalp dense array electroencephalographic video long-term monitoring (LTM) with the aid of source analysis with that obtained from subsequent intracranial ictal recordings.
Ten patients with medically refractory epilepsy, all surgical candidates, underwent intracranial LTM after standard noninvasive evaluation failed to provide adequate localizing information regarding ictal origins. Before invasive studies, all patients underwent dense array electroencephalographic LTM in which habitual clinical seizures were recorded for each patient. Source analysis was applied to ictal onsets. Intracranial electrode placement followed conventional guidelines, although the neurosurgeon was aware of the dense array electroencephalographic results. Patients ranged in age from 10 to 49 years (mean age, 24 y); 7 were male. Identified risk factors included closed head injury in 1 patient and childhood meningitis in another. No focal neurological signs were found in any patient. Magnetic resonance imaging findings were normal in 6 patients; 1 patient had cerebellar hypoplasia, 1 had right frontoparietal dysplasia, 1 had bilateral nonspecific white matter abnormalities, and 1 had bilateral cavernous angiomas.
Ictal onsets, based on invasive recordings, were in the mesiotemporal lobe (3 patients), lateroparietal (2 patients), mesioparietal (1 patient), laterofrontal (1 patient), superolateral frontocentral (1 patient), frontopolar (1 patient), and posteroinferior temporo-occipital neocortex (1 patient). Dense array electroencephalography localized ictal onsets to the same region as intracranial monitoring in 8 of 10 cases; invasive studies disclosed an additional ictal focus in 2 of these patients. Surgical resections were based only on intracranial electroencephalographic findings.
Dense array electroencephalography has the potential to assist in the noninvasive localization of epileptic seizures and to guide the placement of invasive electrodes for localizing seizure onset.
比较利用源分析辅助的高空间分辨率、256 通道头皮密集阵列脑电图视频长程监测（LTM）的发作起始区定位与随后颅内发作记录的定位。
10 例药物难治性癫痫患者，均为手术候选者，在标准的非侵入性评估未能提供足够的关于发作起源的定位信息后，进行颅内 LTM。在进行侵入性研究之前，所有患者均进行了密集阵列脑电图 LTM，为每位患者记录了习惯性临床发作。对发作起始进行源分析。颅内电极放置遵循常规指南，尽管神经外科医生知道密集阵列脑电图的结果。患者年龄 10-49 岁（平均 24 岁）；7 名男性。确定的危险因素包括 1 例闭合性颅脑损伤和另 1 例儿童期脑膜炎。任何患者均未发现局灶性神经体征。6 例患者磁共振成像结果正常；1 例患者小脑发育不全，1 例患者额顶侧发育不良，1 例患者双侧非特异性白质异常，1 例患者双侧海绵状血管瘤。
基于侵入性记录，发作起始位于中颞叶（3 例）、侧顶叶（2 例）、中顶叶（1 例）、侧额叶（1 例）、超外侧额中央（1 例）、额极（1 例）和后下颞枕新皮质（1 例）。在 10 例中的 8 例中，密集阵列脑电图将发作起始定位于与颅内监测相同的区域；在这 2 例患者中，侵入性研究发现了额外的发作灶。手术切除仅基于颅内脑电图发现。
密集阵列脑电图有可能协助非侵入性定位癫痫发作，并指导放置侵入性电极以定位发作起始。
