Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Epilepsy Res. 2012 Nov;102(1-2):71-7. doi: 10.1016/j.eplepsyres.2012.05.003. Epub 2012 May 31.
To clarify the clinical and neurophysiological profiles of fronto-parietal opercular epilepsy in which epileptic spikes are detected with magnetoencephalography (MEG) but not with scalp electroencephalography (EEG).
Four patients presented with epileptic spikes localized to the fronto-parietal opercular cortex, which were only appreciated following MEG recordings.
In all cases, seizure semiology suggested early activation of the operculum and lower peri-rolandic cortex consistent with the somatotopic organization of this region, i.e. tingling sensation involving the throat and hemi-face or contralateral upper limb, and spasms of the neck and throat. MEG spikes were localized in the fronto-parietal operculum. Three of the four patients underwent invasive electrocorticography and/or stereo-EEG recordings, and spikes were confirmed to arise from the estimated area of MEG dipole localization. Two patients remained seizure-free for over 1 year after resection of the epileptogenic region; the other patient declined resective surgery due to proximity to the language cortex.
This study demonstrates the usefulness of MEG in localizing spikes arising from within the fronto-parietal opercular regions, and implies that MEG may provide localizing information in patients with symptoms suggestive of opercular epilepsy, even if scalp EEG recordings fail to disclose any epileptogenic activities.
阐明磁源性影像（MEG）检测到而头皮脑电图（EEG）检测不到棘波的额顶-岛盖部癫痫的临床和神经生理学特征。
4 例患者表现为局灶于额顶-岛盖部皮质的棘波，仅在 MEG 记录后才能观察到。
所有病例的发作症状学均提示岛盖和下近额回皮质的早期激活，这与该区域的躯体感觉组织一致，即涉及喉咙和半面或对侧上肢的刺痛感，以及颈部和喉咙的痉挛。MEG 棘波定位于额顶-岛盖部。这 4 例患者中有 3 例接受了侵袭性皮质脑电图和/或立体脑电图记录，证实棘波确实来自 MEG 偶极子定位的估计区域。2 例患者在切除致痫区后 1 年以上无癫痫发作；另 1 例由于接近语言皮质而拒绝手术切除。
本研究表明 MEG 可用于定位起源于额顶-岛盖部的棘波，并且表明 MEG 可能为有岛盖癫痫症状的患者提供定位信息，即使头皮 EEG 记录未能显示任何致痫性活动。
