Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy.
Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Clin Neurophysiol. 2021 Jul;132(7):1622-1635. doi: 10.1016/j.clinph.2021.03.043. Epub 2021 Apr 28.
To assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.
We examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.
Resection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34-78.2%), a specificity of 85.7% (95% CI, 57.2-98.2%) and an accuracy of 68.6% (95% CI, 50.7-83.5%) (p = 0.01).
Ictal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.
Such an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.
评估在低密度头皮 EEG 上的发作期电源成像（ESI）是否可以近似癫痫发作起始区（SOZ）的位置，并预测接受手术的难治性癫痫儿童的手术结果。
我们检查了 35 名患有难治性癫痫的儿童。我们将手术结果分为癫痫发作和非癫痫发作两种情况。我们确定了头皮和颅内 EEG 记录的发作起始，并使用等效电流偶极子和标准化低分辨率磁断层摄影术（sLORETA）对其进行定位。我们估计头皮 EEG 的定位准确性为头皮偶极子与颅内偶极子之间的距离。我们还计算了头皮偶极子与切除的距离，以及它们的切除百分比，并在癫痫发作和非癫痫发作患者之间进行了比较。我们构建了受试者工作特征曲线，以测试切除百分比是否可以预测结果。
在癫痫发作患者中，头皮 EEG 的两种偶极子（p=0.006）和 sLORETA（p=0.04）的切除距离均较低。切除百分比预测结果的敏感性为 57.1%（95%CI，34-78.2%），特异性为 85.7%（95%CI，57.2-98.2%），准确性为 68.6%（95%CI，50.7-83.5%）（p=0.01）。
在低密度头皮 EEG 上进行的发作期 ESI 可以描绘 SOZ 并预测结果。
这种应用可能会增加被推荐接受癫痫手术的儿童数量，并改善他们的结果。
