Lee Yun Jeong, Bae Hyunwoo, Byun Jun Chul, Kwon Soonhak, Oh Sung Suk, Kim Saeyoon
Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
Department of Pediatrics, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
J Clin Neurol. 2022 Sep;18(5):535-546. doi: 10.3988/jcn.2022.18.5.535.
The current study analyzed the interictal epileptiform discharge (IED)-related hemodynamic response and aimed to determine the clinical usefulness of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) in defining the epileptogenic zone (EZ) in children with focal epilepsy.
Patients with focal epilepsy showing IEDs on conventional EEG were evaluated using EEG-fMRI. Statistical analyses were performed using the times of spike as events modeled with multiple hemodynamic response functions. The area showing the most significant -value for blood-oxygen-level-dependent (BOLD) changes was compared with the presumed EZ. Moreover, BOLD responses between -9 and +9 s around the spike times were analyzed to track the hemodynamic response patterns over time.
Half (=13) of 26 EEG-fMRI investigations of 19 patients were successful. Two patients showed 2 different types of spikes, resulting in 15 analyses. The maximum BOLD response was concordant with the EZ in 11 (73.3%) of the 15 analyses. In 10 (66.7%) analyses, the BOLD response localized the EZs more specifically. Focal BOLD responses in the EZs occurred before IEDs in 11 analyses and were often widespread after IEDs. Hemodynamic response patterns were consistent in the same epilepsy syndrome or when repeating the investigation in the same patients.
EEG-fMRI can provide additional information for localizing the EZ in children with focal epilepsy, and also reveal the pathogenesis of pediatric epilepsy by evaluating the patterns in the hemodynamic response across time windows of IEDs.
本研究分析了发作间期癫痫样放电（IED）相关的血流动力学反应，旨在确定同步脑电图和功能磁共振成像（EEG-fMRI）在明确局灶性癫痫患儿致痫区（EZ）方面的临床实用性。
对在常规脑电图上显示有IED的局灶性癫痫患者进行EEG-fMRI评估。使用尖峰次数作为事件，采用多种血流动力学反应函数进行统计分析。将显示血氧水平依赖（BOLD）变化最显著P值的区域与假定的EZ进行比较。此外，分析尖峰时间前后-9至+9秒之间的BOLD反应，以追踪血流动力学反应模式随时间的变化。
19例患者的26次EEG-fMRI检查中有一半（=13次）成功。2例患者显示出2种不同类型的尖峰，共进行了15次分析。在15次分析中的11次（73.3%）中，最大BOLD反应与EZ一致。在10次（66.7%）分析中，BOLD反应更精确地定位了EZ。在11次分析中，EZ中的局灶性BOLD反应在IED之前出现，且在IED之后往往广泛分布。在同一癫痫综合征或同一患者重复检查时，血流动力学反应模式是一致的。
EEG-fMRI可为局灶性癫痫患儿定位EZ提供额外信息，还可通过评估IED不同时间窗内的血流动力学反应模式揭示小儿癫痫的发病机制。
