Epilepsy Center, Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, D-91052 Erlangen, Germany.
Epilepsy Res. 2010 Nov;92(1):54-62. doi: 10.1016/j.eplepsyres.2010.08.007. Epub 2010 Sep 21.
Unilateral monofocal temporal magnetoencephalography (MEG) findings might determine epileptogenicity of a lesion in symptomatic epilepsy during presurgical evaluation. To evaluate the additive effect of video-electroencephalography (vEEG), monofocal temporal lobe MEG findings were compared to electrophysiological findings from vEEGs of patients with lesional epilepsy.
In 28 patients with drug-resistant lesional temporal lobe epilepsy (TLE), epileptogenicity of the lesion was determined by monofocal temporal MEG localisations. Findings for lesions of different aetiologies (20 mesial, 6 lateral, and 2 extended mesiolateral lesions) were compared to electrophysiological findings from long-term vEEG monitoring and validated by histology and postsurgical outcome (mean follow-up: 2 years (range 0.5-5)).
The mean distance between a lesion and MEG localisation was 11mm (range 0-30mm). The distance to the lesion was on average 5mm (range 0-22mm) in patients with neocortical foci and on average 13mm (range 0-30mm) in patients with mesial foci. Predominant interictal and ictal vEEG findings were consistent with MEG findings in all patients, although they were sometimes distributed over multiple lobes and bilaterally pronounced on the side of the MEG findings. Postsurgical outcome of Engel 1 could be achieved in 82% (23 patients), and none of the patients had an outcome worse than Engel 2.
MEG localisations in lesional TLE are able to determine epileptogenicity of mesial and lateral temporal lobe lesions. MEG results are consistent with predominant electrophysiological findings from long-term vEEG. Future studies should assess the substitutability of vEEG by MEG in selected cases.
单侧单灶颞区磁共振脑磁图（MEG）的发现可能有助于在术前评估中确定症状性癫痫患者病变的致痫性。为了评估视频脑电图（vEEG）的附加作用，将单灶颞叶 MEG 发现与致痫性病变患者 vEEG 的电生理发现进行了比较。
在 28 例药物难治性致痫性颞叶癫痫（TLE）患者中，通过单灶颞区 MEG 定位确定病变的致痫性。比较不同病因的病变（20 例内侧、6 例外侧和 2 例扩展内侧外侧病变）的结果与长期 vEEG 监测的电生理发现，并通过组织学和术后结果进行验证（平均随访时间：2 年（范围 0.5-5 年））。
病变与 MEG 定位之间的平均距离为 11mm（范围 0-30mm）。在有皮质病灶的患者中，病灶与病灶的距离平均为 5mm（范围 0-22mm），在有内侧病灶的患者中，病灶与病灶的距离平均为 13mm（范围 0-30mm）。尽管有时分布在多个脑叶，并且在 MEG 发现的同侧呈双侧分布，但所有患者的主要间期和发作期 vEEG 发现与 MEG 发现一致。Engel 1 级的术后结果可达到 82%（23 例），没有患者的结果比 Engel 2 级差。
在致痫性 TLE 中，MEG 定位能够确定内侧和外侧颞叶病变的致痫性。MEG 结果与长期 vEEG 的主要电生理发现一致。未来的研究应评估在选定病例中 vEEG 被 MEG 替代的可能性。
