Garcia-Tarodo Stephanie, Funke Michael, Caballero Lisa, Zhu Liang, Shah Manish N, Von Allmen Gretchen K
Pediatric Epilepsy Unit, Division of Child and Adolescent Neurology, Children's Memorial Hermann Hospital, Houston, Texas, U.S.A.
Clinical and Translational Sciences, McGovern Medical School at UTHealth, Houston, Texas, U.S.A.
J Clin Neurophysiol. 2018 Nov;35(6):454-462. doi: 10.1097/WNP.0000000000000500.
Magnetoencephalography (MEG) is often incorporated into the presurgical work-up of children with pharmacoresistant epilepsy. There is growing literature on its role in improving selection for epilepsy surgery, particularly when brain MRI is "non-lesional" or in patients with recurrence or intractable seizures after epilepsy surgery. There are, however, no reports on the extrapolation of its role in the presurgical decision-making process of infants.
We performed a retrospective analysis of infants who underwent MEG over a 10-year period at our center for presurgical work-up. We reviewed medical records to ascertain seizure history, work-up procedures including brain MRI and scalp EEG, and in the case of surgery, intracranial recordings, operative notes, and follow-up outcomes.
We identified 31 infants (<2 years of age) who underwent MEG recordings. Despite EEG interictal readings showing patterns of generalized dysfunction in 80%, MEG was able to pinpoint the foci of epileptic activity in 45%. In the MRI-negative group, 44% had focal lateralized interictal spikes on MEG. The sensitivity of MEG to detect interictal epileptiform activity was 90%, and its ability to provide additional information was 28%. Among 18 infants who had surgery, 13 became seizure free at follow-up. The percentage of infants with a focal spike volume on MEG studies and a seizure-free outcome was 66%.
MEG recordings in infants were found to be as sensitive for identifying seizure focus as other age groups, also supplying additional information to the decision-making process and validating its role in the presurgical work-up of infants with intractable epilepsy.
脑磁图（MEG）常被纳入药物难治性癫痫患儿的术前评估中。关于其在改善癫痫手术选择中的作用，相关文献日益增多，特别是当脑部磁共振成像（MRI）“无病变”时，或在癫痫手术后复发或难治性癫痫发作的患者中。然而，尚无关于其在婴儿术前决策过程中作用推断的报道。
我们对在我们中心接受MEG检查以进行术前评估的婴儿进行了为期10年的回顾性分析。我们查阅了病历，以确定癫痫发作史、包括脑部MRI和头皮脑电图在内的评估程序，以及在手术情况下的颅内记录、手术记录和随访结果。
我们确定了31名接受MEG记录的婴儿（<2岁）。尽管脑电图发作间期读数显示80%存在广泛性功能障碍模式，但MEG能够在45%的病例中精确定位癫痫活动焦点。在MRI阴性组中，44%在MEG上有局灶性侧化发作间期棘波。MEG检测发作间期癫痫样活动的敏感性为90%，其提供额外信息的能力为28%。在18名接受手术的婴儿中，13名在随访时无癫痫发作。MEG研究中有局灶性棘波容积且无癫痫发作结果的婴儿比例为66%。
发现婴儿的MEG记录在识别癫痫发作焦点方面与其他年龄组一样敏感，也为决策过程提供了额外信息，并验证了其在难治性癫痫婴儿术前评估中的作用。
