Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; The Hillingdon Hospital NHS Foundation Trust, London, UK.
Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Clin Neurophysiol. 2020 Mar;131(3):734-743. doi: 10.1016/j.clinph.2019.12.408. Epub 2020 Jan 20.
To localize the seizure onset zone (SOZ) and irritative zone (IZ) using electric source imaging (ESI) on intracranial EEG (iEEG) and assess their clinical value in predicting epilepsy surgery outcome in children with focal cortical dysplasia (FCD).
We analyzed iEEG data from 25 children with FCD-associated medically refractory epilepsy (MRE) who underwent surgery. We performed ESI on ictal onset to localize SOZ (ESI-SOZ) and on interictal discharges to localize IZ (ESI-IZ). We tested whether resection of ESI-SOZ and ESI-IZ predicted good surgical outcome (Engel 1). We further compared the prediction performance of ESI-SOZ and ESI-IZ to those of SOZ and IZ defined using conventional methods, i.e. by identifying iEEG-contacts showing ictal onsets (conventional-SOZ) or being the most interictally active (conventional-IZ).
The proximity of ESI-SOZ (p = 0.043, odds-ratio = 3.9) and ESI-IZ (p = 0.011, odds-ratio = 7.04) to resection has higher effect on patients' outcome than proximity of conventional-SOZ (p = 0.17, odds-ratio = 1.7) and conventional-IZ (p = 0.038, odds-ratio = 2.6). Resection of ESI-SOZ and ESI-IZ presented higher discriminative power in predicting outcome (68% and 60%) than conventional-SOZ and conventional-IZ (48% and 53%).
Localizing SOZ and IZ via ESI on iEEG offers higher predictive value compared to conventional-iEEG interpretation.
iEEG-ESI may help surgical planning and facilitate prognostic assessment of children with FCD-associated MRE.
使用颅内脑电图（iEEG）的电源成像（ESI）定位发作起始区（SOZ）和刺激性区（IZ），并评估其在预测伴有局灶性皮质发育不良（FCD）的儿童药物难治性癫痫（MRE）手术结果中的临床价值。
我们分析了 25 例接受手术的伴有 FCD 相关药物难治性癫痫（MRE）的儿童的 iEEG 数据。我们对发作起始时进行 ESI 以定位 SOZ（ESI-SOZ），并对间期放电进行 ESI 以定位 IZ（ESI-IZ）。我们测试了切除 ESI-SOZ 和 ESI-IZ 是否可以预测良好的手术结果（Engel 1）。我们进一步比较了 ESI-SOZ 和 ESI-IZ 与使用传统方法定义的 SOZ 和 IZ（即通过识别显示发作起始的 iEEG 触点[传统 SOZ]或最活跃的间期放电[传统 IZ]）的预测性能。
ESI-SOZ（p=0.043，优势比=3.9）和 ESI-IZ（p=0.011，优势比=7.04）与切除的接近程度对患者预后的影响大于传统 SOZ（p=0.17，优势比=1.7）和传统 IZ（p=0.038，优势比=2.6）。切除 ESI-SOZ 和 ESI-IZ 在预测结果方面具有更高的判别力（68%和 60%），而传统 SOZ 和传统 IZ 则分别为 48%和 53%。
与传统 iEEG 解释相比，使用 iEEG 的 ESI 定位 SOZ 和 IZ 提供了更高的预测价值。
iEEG-ESI 可能有助于手术计划，并促进伴有 FCD 相关 MRE 的儿童的预后评估。
