Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8043, USA.
Epilepsia. 2011 Sep;52(9):1733-40. doi: 10.1111/j.1528-1167.2011.03191.x. Epub 2011 Jul 29.
In planning epilepsy surgery, it is important to be able to assess the likelihood of success of surgery for each patient so that the possible risk and benefit can be properly considered. In this study, functional connectivity was investigated as a means for predicting surgical outcome from the preoperative functional magnetic resonance imaging (fMRI) of epilepsy patients.
Resting-state simultaneous electroencephalography (EEG)-fMRI data were collected from 18 patients with intractable epilepsy before surgery and from 14 healthy subjects. For each patient, EEG-spike correlated fMRI analysis was performed and an activation cluster that overlapped the most with the planned resection area for each patient was chosen as the seed for the functional connectivity analysis. After the functional connectivity maps were computed, laterality indices of functional connectivity were contrasted between patients who had seizures after surgeries (seizure-recurrence group) and those who did not have them for at least a year (seizure-free group).
Patients in the seizure-recurrence group had less-lateralized functional connectivity than patients in the seizure-free group (t(16) = 2.3, after control subtracted and Fisher transformed, p < 0.05, two-tailed).
This study suggests the potential for using preoperative fMRI connectivity analysis as a predictive outcome measure. If confirmed by further research, a high laterality will be an important addition to the other predictors of better surgical outcome such as febrile seizures, mesial temporal sclerosis, tumors, abnormal MRI, and EEG/MRI concordance.
在规划癫痫手术时，重要的是能够评估每位患者手术成功的可能性，以便能够充分考虑可能的风险和获益。本研究旨在通过癫痫患者术前功能磁共振成像（fMRI）来探讨功能连接作为预测手术结果的一种手段。
在术前，我们对 18 例耐药性癫痫患者和 14 例健康受试者采集了静息态同步脑电图（EEG）-fMRI 数据。对每位患者进行 EEG 棘波相关 fMRI 分析，并选择与每位患者计划切除区域重叠最多的激活簇作为功能连接分析的种子。计算功能连接图后，比较术后有癫痫发作（癫痫复发组）和至少 1 年无癫痫发作（无癫痫发作组）患者的功能连接的偏侧性指数。
与无癫痫发作组相比，癫痫复发组的功能连接偏侧性降低（t(16) = 2.3，控制后减去 Fisher 转换，p < 0.05，双侧）。
本研究提示术前 fMRI 连接分析具有作为预测结果的测量指标的潜力。如果进一步的研究得到证实，高偏侧性将是更好手术结果的其他预测因素（如热性惊厥、内侧颞叶硬化、肿瘤、异常 MRI 和 EEG/MRI 一致性）的重要补充。
