Stichting Epilepsy Instellingen Nederland, Heemstede, Netherlands.
University Medical Center Utrecht, Utrecht, Netherlands.
Nat Rev Neurol. 2019 Oct;15(10):594-606. doi: 10.1038/s41582-019-0224-y.
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
癫痫手术候选人必须接受术前评估,以确定手术治疗是否可以在不引起神经功能缺陷的情况下停止癫痫发作,以及如何进行手术治疗。各种技术,包括 MRI、PET、单光子发射 CT、视频-EEG、脑磁图和侵入性 EEG,旨在识别病变脑组织和相关网络。最近的技术和方法学发展,包括现有技术的进步和技术组合的新方式,都在提高确定最佳切除策略的能力。多模态解释和预测性计算机模型有望辅助手术计划和患者咨询,而多模态术中指导可能会提高手术精度。在这篇综述中,我们讨论了这些新方法所获得的知识如何挑战我们对手术治疗局灶性癫痫的思维方式。特别是,我们强调了超越 EEG 发作起始区的重要性,并将局灶性癫痫视为一种脑网络疾病,其中需要考虑长程连接。我们还探讨了新的诊断技术如何揭示以前看不见的大脑中的重要信息。
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