Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland.
Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland; EEG and Epilepsy Unit, Neurology Clinic, University Hospital and Faculty of Medicine of Geneva, Switzerland.
Epilepsy Res. 2014 Feb;108(2):267-79. doi: 10.1016/j.eplepsyres.2013.11.003. Epub 2013 Nov 19.
Patients with tuberous sclerosis complex (TSC) often suffer from medically refractory epilepsy. Despite the multifocality of the disease, resection of the most epileptogenic tuber can lead to major improvement of seizure control. Therefore, non-invasive imaging methods are needed for detecting epileptogenic sources. We assessed the utility of electric source imaging (ESI) in the presurgical work-up of TSC patients and its combination with Positron Emission Tomography (PET) and ictal/interictal Single Photon Emission Computed Tomography (SISCOM).
Thirteen patients underwent high density ESI (8/13) and/or low density ESI (13/13). We investigated the concordance between ESI, PET, SISCOM and the resection area in the 11 operated patients (nine seizure-free).
High resolution ESI was partially or completely concordant with the resected area in 5/5 seizure free patients. Low resolution ESI was partially or completely concordant in 7/9 seizure free patients. PET and SPECT were concordant (partially or completely) in 8/9 and 6/9 cases, respectively. We found multifocal ESI sources in 2/9 seizure free patients, marked multifocal PET hypometabolism in 3/9 and multifocal SISCOM in 4/9. The region of concordant ESI and PET accurately predicted the dominant epileptogenic source in 6/9 patients. The same was true for concordant ESI and SISCOM in 4/9 patients, whereas the coregistration of only PET and SISCOM was insufficient in 3/9 successfully operated cases. The combination of all three imaging modalities could successfully identify the resection area in all but one patient with a favorable post-operation outcome.
ESI is an important tool for the pre-surgical evaluation of TSC patients. It complements PET and SPECT results and can improve the management of candidates for surgery when integrated with electro-clinical information.
结节性硬化症（TSC）患者常患有药物难治性癫痫。尽管疾病呈多灶性，但切除最致痫性的结节可导致癫痫发作控制的显著改善。因此，需要非侵入性成像方法来检测致痫源。我们评估了电源成像（ESI）在 TSC 患者术前评估中的效用及其与正电子发射断层扫描（PET）和发作期/发作间期单光子发射计算机断层扫描（SISCOM）的结合。
13 例患者接受高密度 ESI（8/13）和/或低密度 ESI（13/13）检查。我们研究了 ESI、PET、SISCOM 与 11 例手术患者（9 例无癫痫发作）的切除区域之间的一致性。
高分辨率 ESI 在 5/5 例无癫痫发作患者中部分或完全与切除区域一致。低分辨率 ESI 在 7/9 例无癫痫发作患者中部分或完全一致。PET 和 SPECT 分别在 8/9 和 6/9 例中部分或完全一致。我们在 2/9 例无癫痫发作患者中发现了多灶性 ESI 源，在 3/9 例患者中发现了多灶性 PET 代谢低下，在 4/9 例患者中发现了多灶性 SISCOM。在 6/9 例患者中，有 ESI 和 PET 一致的区域准确地预测了主要致痫源，在 4/9 例患者中，ESI 和 SISCOM 一致的情况也是如此，而在 3/9 例成功手术的患者中，仅 PET 和 SISCOM 的配准是不够的。当将所有三种成像方式结合起来时，除了 1 例患者外，所有患者都能成功地识别出切除区域，且术后结果良好。
ESI 是 TSC 患者术前评估的重要工具。它补充了 PET 和 SPECT 的结果，并在与电临床信息相结合时，可以改善手术候选者的管理。
