Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Neuromodulation, Beijing, China.
Epilepsia Open. 2024 Apr;9(2):765-775. doi: 10.1002/epi4.12896. Epub 2024 Jan 23.
Presurgical evaluation is still challenging for MRI-negative epilepsy patients. As non-invasive modalities are the easiest acceptable and economic methods in determining the epileptogenic zone, we analyzed the localization value of common non-invasive methods in MRI-negative epilepsy patients. In this study, we included epilepsy patients undergoing presurgical evaluation with presurgical negative MRI. MRI post-processing was performed using a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI. The relationship between MAP, magnetoencephalography (MEG), scalp electroencephalogram (EEG), and seizure outcomes was analyzed to figure out the localization value of different non-invasive methods. Eighty-six patients were included in this study. Complete resection of the MAP-positive regions or the MEG-positive regions was positively associated with seizure freedom (p = 0.028 and 0.007, respectively). When an area is co-localized by MAP and MEG, the resection of the area was significantly associated with seizure freedom (p = 0.006). However, neither the EEG lateralization nor the EEG localization showed statistical association with the surgical outcome (p = 0.683 and 0.505, respectively). In conclusion, scalp EEG had a limited role in presurgical localization and predicting seizure outcome, combining MAP and MEG results can significantly improve the localization of epileptogenic lesions and have a positive association with seizure-free outcome. PLAIN LANGUAGE SUMMARY: Due to the lack of obvious structure abnormalities on neuroimaging examinations, the identification of epilepsy lesions in MRI-negative epilepsy patients can be difficult. In this study, we intended to use non-invasive examinations to explore the potential epileptic lesions in MRI-negative epilepsy patients and to determine the results accuracy by comparing the neuroimaging results with the epilepsy surgery outcomes. A total of 86 epilepsy patients without obvious structure lesions on MRI were included, and we found that the combinations of different non-invasive examinations and neuroimaging post-processing methods are significantly associated with the seizure freedom results of epilepsy surgery.
术前评估对于 MRI 阴性癫痫患者仍然具有挑战性。由于非侵入性方法是确定致痫区最容易接受和经济的方法，因此我们分析了常见非侵入性方法在 MRI 阴性癫痫患者中的定位价值。在这项研究中，我们纳入了接受术前评估且 MRI 术前阴性的癫痫患者。使用形态计量分析程序 (MAP) 在 T1 加权容积 MRI 上对 MRI 进行后处理。分析 MAP、脑磁图 (MEG)、头皮脑电图 (EEG) 与癫痫发作结果之间的关系，以确定不同非侵入性方法的定位价值。本研究共纳入 86 例患者。MAP 阳性区域或 MEG 阳性区域的完全切除与无癫痫发作显著相关 (p = 0.028 和 0.007)。当一个区域同时被 MAP 和 MEG 定位时，该区域的切除与无癫痫发作显著相关 (p = 0.006)。然而，脑电图的侧化和定位均与手术结果无统计学关联 (p = 0.683 和 0.505)。总之，头皮 EEG 在术前定位和预测癫痫发作结果方面作用有限，结合 MAP 和 MEG 的结果可以显著提高致痫病灶的定位，与无癫痫发作结果呈正相关。
