Boon P, D'Havé M
Department of Neurology, University Hospital, Gent, Belgium.
Acta Neurol Scand. 1995 Jul;92(1):7-18. doi: 10.1111/j.1600-0404.1995.tb00460.x.
Fifteen patients (7 men, 8 women) with mean age of 34 years and mean duration of refractory partial seizures of 17 years were included in a presurgical evaluation protocol. Neuroimaging (CAT, 1.5 T MR) demonstrated intracranial structural lesions (space-occupying: n = 9; atrophic: n = 6) and video-EEG monitoring showed complex partial seizures in all patients. Four patients underwent additional intracranial EEG monitoring that demonstrated hippocampal seizure onset in all. Voltage topography and spatiotemporal dipole mapping of interictal epileptic discharges revealed two distinct distinct dipole types. Patients with lesions in the medial (and lateral) temporal lobe uniformly presented with a negative voltage field with a steep gradient over the inferior temporal area and a stable, combined dipole that consisted of a radial and a tangential component with a high degree of elevation relative to the axial plane. Patients with extratemporal lesions had a more diffuse, less dipolar voltage field and a corresponding dipole which was less stable and had a predominant radial component. Dipole modelling of epochs of early ictal discharges revealed a striking correspondence with the interictal findings in individual patients. Interictal spike voltage topography and corresponding dipole mapping provided additional and reliable information that was relevant in surgical candidates for refractory partial epilepsy, e.g. by suggesting in some patients that the medial temporal structures were not primarily involved. Ictal dipole modelling revealed concordant results with interictal data. It shows promising but needs further confirmation and validation in a larger patient population with intracranial EEG recordings. Despite intrinsic limitations, spike voltage topography and dipole mapping contributes to a better localisation of the underlying brain source of epileptic discharges.
15例患者（7例男性，8例女性）纳入术前评估方案，平均年龄34岁，难治性部分性癫痫平均病程17年。神经影像学检查（CAT、1.5T MR）显示颅内结构性病变（占位性：n = 9；萎缩性：n = 6），视频脑电图监测显示所有患者均有复杂部分性发作。4例患者接受了额外的颅内脑电图监测，结果显示均为海马区发作起始。发作间期癫痫放电的电压地形图和时空偶极子映射显示出两种不同的偶极子类型。颞叶内侧（和外侧）有病变的患者在下颞叶区域均呈现出负电压场，其梯度陡峭，还有一个稳定的复合偶极子，由一个径向分量和一个切向分量组成，相对于轴平面有高度的仰角。颞叶外病变的患者有更弥散、偶极子性更弱的电压场以及一个相应的偶极子，其稳定性较差且以径向分量为主。早期发作期放电的偶极子建模显示与个体患者的发作间期结果有显著对应关系。发作间期棘波电压地形图和相应的偶极子映射提供了额外且可靠的信息，这对于难治性部分性癫痫的手术候选患者很重要，例如在一些患者中提示颞叶内侧结构并非主要受累部位。发作期偶极子建模显示与发作间期数据结果一致。它显示出前景，但需要在更大规模的颅内脑电图记录患者群体中进一步证实和验证。尽管存在固有局限性，但棘波电压地形图和偶极子映射有助于更好地定位癫痫放电的潜在脑源。
