Department of Neurosciences, Mater Misericordiae Hospital, Brisbane, Queensland, Australia; Mater Research Institute, Faculty of Medicine, University of Queensland, Australia; Queensland Brain Institute, University of Queensland, Australia.
Department of Neurology, St Vincent's Hospital, Fitzroy, Australia; School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Medicine, University of Melbourne, Parkville, Australia.
Neurophysiol Clin. 2024 Nov;54(6):103021. doi: 10.1016/j.neucli.2024.103021. Epub 2024 Oct 25.
Surgical resection for epilepsy often fails due to incomplete Epileptogenic Zone Network (EZN) localization from scalp electroencephalography (EEG), stereo-EEG (SEEG), and Magnetic Resonance Imaging (MRI). Subjective interpretation based on interictal, or ictal recordings limits conventional EZN localization. This study employs multimodal analysis using high-density-EEG (HDEEG), Magnetoencephalography (MEG), functional-MRI (fMRI), and SEEG to overcome these limitations in a patient with drug-resistant MRI-negative focal epilepsy. A 17-year-old with drug-resistant epilepsy underwent evaluation. HDEEG, MEG, fMRI, and SEEG were used, with a novel HDEEG-cap facilitating simultaneous EEG-MEG and EEG-fMRI recordings. Electrical and magnetic source imaging were performed, and fMRI data were analysed for homogenous regions. SEEG analysis involved spike detection, spike timing analysis, ictal fast activity quantification, and Granger-based connectivity analysis. Non-invasive sessions revealed consistent interictal source imaging results identifying the EZN in the right anterior cingulate cortex. EEG-fMRI highlighted broader activation in the right cingulate cortex. SEEG analysis localized spikes and fast activity in the right anterior and posterior cingulate gyri. Multi-modal analysis suggested the EZN in the right frontal lobe, primarily involving the anterior and mid-cingulate cortices. Multi-modal non-invasive analyses can optimise SEEG implantation and surgical decision-making. Invasive analyses corroborated non-invasive findings, emphasising the importance of individual-case quantitative analysis across modalities in complex epilepsy cases.
由于头皮脑电图 (EEG)、立体脑电图 (SEEG) 和磁共振成像 (MRI) 无法完全定位致痫区网络 (EZN)，手术切除癫痫往往失败。基于发作间期或发作期记录的主观解释限制了常规 EZN 定位。本研究采用高密度脑电图 (HDEEG)、脑磁图 (MEG)、功能磁共振成像 (fMRI) 和 SEEG 的多模态分析，克服了耐药性 MRI 阴性局灶性癫痫患者的这些局限性。一名 17 岁耐药性癫痫患者接受了评估。使用了 HDEEG、MEG、fMRI 和 SEEG，一种新型的 HDEEG 帽促进了 EEG-MEG 和 EEG-fMRI 的同步记录。进行了电和磁源成像，并对 fMRI 数据进行了同质性区域分析。SEEG 分析包括检测棘波、棘波时间分析、发作性快活动定量和基于格兰杰的连通性分析。非侵入性检查显示一致的发作间期源成像结果，确定了右前扣带回皮层的 EZN。EEG-fMRI 突出了右扣带回皮层更广泛的激活。SEEG 分析定位了右前和后扣带回的棘波和快活动。多模态分析提示 EZN 位于右额叶，主要涉及前扣带和中扣带皮质。多模态非侵入性分析可以优化 SEEG 植入和手术决策。侵入性分析证实了非侵入性发现，强调了在复杂癫痫病例中对各模式进行个体化定量分析的重要性。
