University of Melbourne, Melbourne, Australia.
Epilepsy Behav. 2010 Dec;19(4):631-4. doi: 10.1016/j.yebeh.2010.09.018. Epub 2010 Oct 27.
Periventricular nodular heterotopia (PVNH) is a malformation of cortical development associated with epilepsy. It is unclear whether the epileptogenic focus is the nodule, overlying cortex, or both. We performed electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) in a patient with bilateral PVNH, capturing 45 "left temporal" epileptiform discharges. The relative time at which fMRI-involved regions became active was assessed. Additionally, nodule-cortex interactions were explored using fMRI functional connectivity. There was EEG-fMRI activity in specific periventricular nodules and overlying cortex in the left temporoparietal region. In both nodules and cortex, the peak BOLD response to epileptiform events occurred earlier than expected from standard fMRI hemodynamic modeling. Functional connectivity showed nodule-cortex interactions to be strong in this region, even when the influence of fMRI activity fluctuations due to spiking was removed. Nonepileptogenic, contralateral nodules did not show connectivity with overlying cortex. EEG-fMRI and functional connectivity can help identify which of the multiple abnormal regions are epileptogenic in PVNH.
脑室周围结节性异位（PVNH）是一种与癫痫相关的皮质发育畸形。尚不清楚致痫灶是结节、覆盖皮质还是两者兼而有之。我们对一名双侧 PVNH 患者进行了脑电图（EEG）-功能磁共振成像（fMRI）检查，共捕捉到 45 次“左侧颞叶”癫痫样放电。评估了 fMRI 相关区域何时开始活跃。此外，还使用 fMRI 功能连接探索了结节-皮质相互作用。在左侧颞顶叶区域，存在特定的脑室周围结节和覆盖皮质的 EEG-fMRI 活动。在结节和皮质中，与癫痫样事件相关的 BOLD 反应峰值比标准 fMRI 血流动力学模型预期的更早出现。功能连接显示该区域的结节-皮质相互作用很强，即使去除了由于尖峰引起的 fMRI 活动波动的影响。非致痫性对侧结节与覆盖皮质之间没有连接。EEG-fMRI 和功能连接有助于确定 PVNH 中多个异常区域中哪些是致痫性的。
