Neurology Department, University Hospital of Nancy, Nancy, France.
CRAN, UMR 7039, Lorraine University, Vandœuvre-les-Nancy Cedex, France.
Neuroimage Clin. 2017 Aug 8;16:319-329. doi: 10.1016/j.nicl.2017.08.009. eCollection 2017.
We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ.
In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation for focal drug-resistant epilepsy. Electric source imaging (ESI) was performed before SEEG. Source localizations were obtained from dipolar and distributed source methods. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded to- and subsequently compared with SEEG estimated EZ.
74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and medio-lateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; = 0.05), (ii) cases of negative MRI (36%; = 0.01) and (iii) MCD (27%; = 0.03). The rate of ESI full concordance with EZ was not statistically different according to the depth of the EZ.
We prospectively demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD.
我们旨在前瞻性评估立体脑电图（SEEG）评估的致痫区（EZ）与间期放电的电源定位的解剖学一致性，根据不同亚组：癫痫类型、结构 MRI 病变、病因和 EZ 深度。
在一项前瞻性多中心观察性研究中，我们招募了 85 名连续接受局灶性耐药性癫痫手术前 SEEG 检查的患者。在 SEEG 之前进行了电源成像（ESI）。使用偶极子和分布式源方法获得源定位。根据 36 个预定义的亚叶区定义 ESI 与 EZ 之间的解剖学一致性。ESI 解释为盲法，随后与 SEEG 估计的 EZ 进行比较。
最终分析了 74 名患者。38 例患者有颞叶和 36 例颞叶外癫痫。MRI 阳性 52 例。41 例患者有皮质发育不良（MCD），33 例有其他或未知病因。EZ 为内侧 27 例，外侧 13 例，中外侧 34 例。在整个队列中，ESI 完全或部分定位 EZ 的比例为 85%：完全一致 13 例，部分一致 50 例。ESI 与 EZ 完全一致的比例在（i）额叶癫痫（46%；=0.05）、（ii）MRI 阴性（36%；=0.01）和（iii）MCD（27%；=0.03）中显著更高。根据 EZ 的深度，ESI 与 EZ 完全一致的比例没有统计学差异。
我们前瞻性地证明，ESI 更准确地估计了在癫痫手术中最困难的患者亚组中的 EZ：额叶癫痫、MRI 阴性和 MCD 存在。
