Functional Brain Mapping Laboratory, 4 Rue Gabrielle-Perret-Gentil, Geneva, Switzerland.
Epilepsia. 2010 Apr;51(4):583-91. doi: 10.1111/j.1528-1167.2010.02521.x. Epub 2010 Feb 26.
Patients with magnetic resonance (MR)-negative focal epilepsy (MRN-E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60-90%). Patients with extratemporal MRN-E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI.
We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow-up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring.
ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes.
The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process.
与 MRI 指导手术干预部位的患者（60-90%）相比，磁共振阴性局灶性癫痫（MRN-E）患者的手术结果较差（40%-70%之间）。颞叶外 MRN-E 患者的预后最差（约 50%的癫痫发作无自由机会）。我们研究了在 MRI 正常的患者中，发作间期癫痫活动的脑电图源成像（ESI）是否有助于确定癫痫灶。
我们对 10 例非病变性 MRI 手术患者进行了 ESI，并进行了至少 1 年的术后随访。这 10 例患者中有 5 例患有颞叶外癫痫。评估包括对发作期和发作间期事件进行表面和颅内脑电图监测、结构 MRI、[（18）F]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）、发作期和发作间期灌注单光子发射计算机断层扫描（SPECT）扫描。其中 8 例患者还接受了颅内监测。
ESI 在 10 例患者中的 8 例中正确定位了切除边缘内的癫痫灶，其中 9 例患者术后结果良好。
结果突出了 ESI 的诊断价值，并鼓励将其应用于 MRN-E 患者。如果表面 EEG 包含相当定位的棘波，则 ESI 有助于术前决策过程。
