Shukla Garima, Kazutaka Jin, Gupta Ajay, Mosher John, Jones Stephen, Alexopoulos Andreas, Burgess Richard C
1 Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA.
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
J Child Neurol. 2017 Oct;32(12):981-995. doi: 10.1177/0883073817724903. Epub 2017 Aug 22.
Children with generalized seizures are often excluded as epilepsy surgery candidates. This prospective study was conducted to evaluate the utility of magnetoencephalography (MEG) to refine the location of the "irritative zone" in children with single lesions on magnetic resonance imaging (MRI) but with generalized ictal electroencephalographic (EEG) findings.
Patients admitted with refractory epilepsy with imaging studies showing focal or hemispheric abnormalities but scalp video EEG showing generalized or multiregional epileptiform abnormalities were included. Patients were encouraged into natural sleep, and simultaneous whole-head MEG/EEG was recorded. Source localization of epileptic spikes on MEG was carried out while blinded to other results. Acceptable dipoles were classified into 3 groups: focal, hemispheric clusters, and single focal cluster with additional widespread dipoles.
Nine patients (4 female, 5 males; ages 10 months to 15 years) were included. Two had focal features on clinical semiology, whereas all had generalized or multiregional interictal and ictal EEG. Etiologies included tuberous sclerosis complex (2), postencephalitic sequelae (1), focal cortical dysplasia (1), and unknown (2). Five patients had clear focal lesions on brain MRI whereas the other 2 had focal positron emission tomography (PET) abnormalities. An average of 38 spikes were accepted (average goodness of fit = 85.3%). A single tight cluster of dipoles was identified in 5 patients, 1 had dipoles with propagation from left occipital to right temporal. One patient had 2 distinct dipole clusters. MEG demonstrated focal findings 9 times more often than the simultaneously recorded scalp EEG, and 3 times more often than the associated multiday video EEG recordings.
This study shows that neurophysiologic evidence of focal epileptiform abnormalities in patients with focal brain lesions and generalized EEG findings can be strengthened using MEG. Further feasibility of surgical candidacy should be evaluated in these patients.
全身性癫痫发作的儿童通常被排除在癫痫手术候选者之外。本前瞻性研究旨在评估脑磁图（MEG）在细化磁共振成像（MRI）显示单一病灶但发作期脑电图（EEG）表现为全身性的儿童“激惹区”位置方面的效用。
纳入难治性癫痫患者，其影像学检查显示局灶性或半球性异常，但头皮视频脑电图显示全身性或多区域癫痫样异常。鼓励患者自然睡眠，同时记录全脑MEG/EEG。在对其他结果不知情的情况下，对MEG上的癫痫棘波进行源定位。可接受的偶极子分为3组：局灶性、半球簇状和伴有额外广泛偶极子的单局灶簇状。
纳入9例患者（4例女性，5例男性；年龄10个月至15岁）。2例在临床症状学上有局灶性特征，而所有患者的发作间期和发作期脑电图均为全身性或多区域。病因包括结节性硬化症（2例）、脑炎后遗症（1例）、局灶性皮质发育不良（1例）和不明病因（2例）。5例患者脑MRI有明确的局灶性病变，另外2例有局灶性正电子发射断层扫描（PET）异常。平均接受38个棘波（平均拟合优度=85.3%）。5例患者中识别出单个紧密的偶极子簇，1例偶极子从左枕叶向右侧颞叶传播。1例患者有2个不同的偶极子簇。MEG显示局灶性结果的频率比同时记录的头皮脑电图高9倍，比相关的多日视频脑电图记录高3倍。
本研究表明，对于有局灶性脑病变且脑电图表现为全身性的患者，使用MEG可增强局灶性癫痫样异常的神经生理学证据。应对这些患者手术候选资格的进一步可行性进行评估。
