Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.
Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.
Ann Neurol. 2019 Sep;86(3):344-356. doi: 10.1002/ana.25547. Epub 2019 Jul 11.
Postoperative resting-state functional magnetic resonance imaging (MRI) in children with intractable epilepsy has not been quantified in relation to seizure outcome. Therefore, its value as a biomarker for epileptogenic pathology is not well understood.
In a sample of children with intractable epilepsy who underwent prospective resting-state seizure onset zone (SOZ)-targeted epilepsy surgery, postoperative resting-state functional MRI (rs-fMRI) was performed 6 to 12 months later. Graded normalization of the postoperative resting-state SOZ was compared to seizure outcomes, patient, surgery, and anatomical MRI characteristics.
A total of 64 cases were evaluated. Network-targeted surgery, followed by postoperative rs-fMRI normalization was significantly (p < 0.001) correlated with seizure reduction, with a Spearman rank correlation coefficient of 0.83. Of 39 cases with postoperative rs-fMRI SOZ normalization, 38 (97%) became completely seizure free. In contrast, of the 25 cases without complete rs-fMRI SOZ normalization, only 3 (5%) became seizure free. The accuracy of rs-fMRI as a biomarker predicting seizure freedom is 94%, with 96% sensitivity and 93% specificity.
Among seizure localization techniques in pediatric epilepsy, network-targeted surgery, followed by postoperative rs-fMRI normalization, has high correlation with seizure freedom. This study shows that rs-fMRI SOZ can be used as a biomarker of the epileptogenic zone, and postoperative rs-fMRI normalization is a biomarker for SOZ quiescence. ANN NEUROL 2019;86:344-356.
针对难治性癫痫患儿，目前尚未对术后静息态功能磁共振成像（rs-fMRI）与癫痫发作结局的相关性进行量化，因此，其作为致痫性病理的生物标志物的价值尚不清楚。
在一组接受前瞻性致痫灶（SOZ）靶向癫痫手术的难治性癫痫患儿中，术后 6 至 12 个月进行了术后静息态 SOZ 的 rs-fMRI 检查。将术后静息态 SOZ 的分级归一化与癫痫发作结局、患者、手术和解剖学 MRI 特征进行比较。
共评估了 64 例病例。网络定向手术，随后进行术后 rs-fMRI 归一化，与癫痫发作减少显著相关（p<0.001），Spearman 秩相关系数为 0.83。在 39 例术后 rs-fMRI SOZ 正常的病例中，38 例（97%）完全无癫痫发作。相比之下，在 25 例术后 rs-fMRI SOZ 未完全正常的病例中，仅有 3 例（5%）无癫痫发作。rs-fMRI 作为预测癫痫无发作的生物标志物的准确性为 94%，灵敏度为 96%，特异性为 93%。
在儿科癫痫的致痫灶定位技术中，网络定向手术，随后进行术后 rs-fMRI 归一化，与癫痫无发作具有高度相关性。本研究表明，rs-fMRI SOZ 可用作致痫区的生物标志物，术后 rs-fMRI 归一化是 SOZ 静止的生物标志物。
