Université de Lorraine, CHRU-Nancy, Service de Neurologie, Nancy, France.
CHRU Sart-Tilman, Service de Neurologie, Liège, Belgium.
Brain Topogr. 2020 May;33(3):384-402. doi: 10.1007/s10548-020-00768-3. Epub 2020 Apr 13.
Interictal electrical source imaging (ESI) encompasses a risk of false localization due to complex relationships between irritative and epileptogenic networks. This study aimed to compare the localizing value of ESI derived from ictal and inter-ictal EEG discharges and to evaluate the localizing value of ESI according to three different subgroups: MRI lesion, presumed etiology and morphology of ictal EEG pattern. We prospectively analyzed 54 of 78 enrolled patients undergoing pre-surgical investigation for refractory epilepsy. Ictal and inter-ictal ESI results were interpreted blinded to- and subsequently compared with stereoelectroencephalography as a reference method. Anatomical concordance was assessed at a sub-lobar level. Sensitivity and specificity of ictal, inter-ictal and ictal plus inter-ictal ESI were calculated and compared according to the different subgroups. Inter-ictal and ictal ESI sensitivity (84% and 75% respectively) and specificity (38% and 50% respectively) were not statistically different. Regarding the sensitivity, ictal ESI was never higher than inter-ictal ESI. Regarding the specificity, ictal ESI was higher than inter-ictal ESI in malformations of cortical development (MCD) (60% vs. 43%) and in MRI positive patients (49% vs. 30%). Within the ictal ESI analysis, we showed a higher specificity for ictal spikes (59%) and rhythmic discharges > 13 Hz (50%) than rhythmic discharges < 13 Hz (37%) and (ii) for MCD (60%) than in other etiologies (29%). This prospective study demonstrates the relevance of a combined interpretation of distinct inter-ictal and ictal analysis. Inter-ictal analysis gave the highest sensitivity. Ictal analysis gave the highest specificity especially in patients with MCD or a lesion on MRI.
发作间期电源成像（ESI）由于刺激性和致痫性网络之间的复杂关系，存在假定位的风险。本研究旨在比较来源于发作期和发作间期 EEG 放电的 ESI 的定位价值，并根据三个不同亚组（MRI 病变、推测病因和发作期 EEG 模式的形态）评估 ESI 的定位价值。我们前瞻性分析了 78 名接受难治性癫痫术前评估的患者中的 54 名。发作期和发作间期 ESI 结果在与立体脑电图作为参考方法进行盲法解读后进行了比较。在亚叶水平评估解剖一致性。根据不同亚组计算和比较发作期、发作间期和发作期加发作间期 ESI 的敏感性和特异性。发作期和发作间期 ESI 的敏感性（分别为 84%和 75%）和特异性（分别为 38%和 50%）无统计学差异。就敏感性而言，发作期 ESI 从未高于发作间期 ESI。就特异性而言，在皮质发育畸形（MCD）（60%比 43%）和 MRI 阳性患者（49%比 30%）中，发作期 ESI 高于发作间期 ESI。在发作期 ESI 分析中，我们发现发作期棘波（59%）和节律性放电>13 Hz（50%）的特异性高于节律性放电<13 Hz（37%）和（ii）MCD（60%）高于其他病因（29%）。这项前瞻性研究表明，对不同的发作间期和发作期分析进行综合解释是合理的。发作间期分析的敏感性最高。发作期分析的特异性最高，尤其是在 MCD 或 MRI 病变患者中。
