Koptelova A, Bikmullina R, Medvedovsky M, Novikova S, Golovteev A, Grinenko O, Korsakova M, Kozlova A, Arkhipova N, Vorobyev A, Melikyan A, Paetau R, Stroganova T, Metsähonkala L
Center for Neurocognitive Research (MEG center), Moscow State University of Psychology and Education, Shelepikhinskaya Naberezhnaya 2a, 123290 Moscow, Russia.
Clinical Neurophysiology Department, HUS Medical Imaging Center, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 340, FI-00029, HUS, Helsinki, Finland.
Epilepsy Res. 2018 Feb;140:162-165. doi: 10.1016/j.eplepsyres.2017.12.014. Epub 2017 Dec 27.
Drug resistant epilepsy (DRE) is common in patients with tuberous sclerosis (TS). Interictal MEG has been shown as a valuable instrument in the presurgical workup. The goal of our study was to evaluate the role of ictal MEG in epileptogenic tuber selection, especially in patients with multiple irritative zones.
The clinical and MEG data of 23 patients with TS and DRE from two medical/research centers were reviewed. Seven pediatric patients, who had seizures during MEG recording and underwent resection or disconnection surgery, were included into the study. Cortical sources of ictal and interictal epileptiform MEG discharges were compared with epileptogenic zone location in six patients with favorable surgery outcome.
In patients who improved substantially after surgery all resected and several other tubers demonstrated epileptiform activity on interictal MEG. Ictal MEG provided crucial information about lobar location of the seizure onset zone (SOZ) in two cases, and in the other four it confirmed the SOZ location derived from the interictal data. In one case, ictal MEG findings were unreliable. In one patient, who did not benefit from surgical treatment, the resected tubers did not overlap with interictal and ictal MEG sources.
The combination of interictal and ictal MEG is a valuable tool for identification of the epileptogenic tuber/tubers in presurgical work-up in patients with TS.
耐药性癫痫（DRE）在结节性硬化症（TS）患者中很常见。发作间期脑磁图（MEG）已被证明是术前评估中的一种有价值的工具。我们研究的目的是评估发作期MEG在致痫结节选择中的作用，尤其是在有多个刺激区的患者中。
回顾了来自两个医学/研究中心的23例TS合并DRE患者的临床和MEG数据。纳入了7例在MEG记录期间发作并接受了切除或离断手术的儿科患者。将6例手术效果良好患者的发作期和发作间期癫痫样MEG放电的皮质来源与致痫区位置进行了比较。
在术后明显改善的患者中，所有切除的结节以及其他几个结节在发作间期MEG上均显示出癫痫样活动。发作期MEG在2例患者中提供了关于发作起始区（SOZ）叶位置的关键信息，在另外4例中，它证实了从发作间期数据得出的SOZ位置。在1例患者中，发作期MEG结果不可靠。在1例未从手术治疗中获益的患者中，切除的结节与发作间期和发作期MEG来源不重叠。
发作间期和发作期MEG的联合是TS患者术前评估中识别致痫结节的有价值工具。
