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背景:多数癫痫患者的癫痫发作经药物治疗可得到控制,但对于难治性癫痫患者来说,手术可能是一种治疗选择,正确定位癫痫患者的致痫灶是癫痫手术成功的基础。癫痫患者的术前评估包括视频脑电图、MRI、正电子发射计算机体层摄影/单光子发射计算机体层摄影和神经心理测试等。脑磁图作为一种新的无创性术前检测技术,已被许多国家用于癫痫外科手术计划和大脑功能的研究。目的:术前采用磁源成像技术进行对手术治疗的难治性癫痫患者进行致痫灶定位,并与无创性视频脑电图对比,参考手术效果,评估其定位价值。设计、时间及地点:回顾性病例分析,于2001-11/2005-12在广东三九脑科医院脑磁图室完成。对象:选择进行脑磁图检查618例的癫痫患者,采集其自发磁场信号进行单偶极子定位分析诊断。对其中149例MRI检查有结构改变、病史在2年以上者进行了手术治疗,病程2~35年,平均9.5年。方法:用148通道全头型脑磁系统(MagnesWH2500,4-DNeuroimaging,SanDiego,CA,USA)在磁屏蔽室采集脑自发磁场,采样频率为508.63Hz,带通为1.0~100Hz,采集30min发作间歇期的自发脑磁,采用单个等效电流偶极子进行数据分析。分析结果最后重叠在MRI-T1加权像上,形成磁源成像。主要观察指标:术前视频脑电图、MRI和脑磁图结果及术后随访结果。结果:30min发作间期的脑磁图检测到明显的癫痫样活动的敏感度为91%,并且大部分患者,其等效偶极子主要分布于结构性异常的边缘和邻近区域。与无创性视频脑电图(38.9%,58/149)相比,利用脑磁图可以对大部分MRI上有病变的患者(62.4%,93/149)进行精确定位并且能够确定切除区域。对资料完整的89例患者进行了3~35个月的随访,平均随访9个月。89例患者中有72例(80.9%)术后未出现癫痫发作(EngelⅠ);7例(7.9%)癫痫发作极少或癫痫发作频率减少90%以上(EngelⅡ和EngelⅢ);10例(11.2%)癫痫发作频率无明显减少(EngelⅣ和EngelⅤ),总有效率达88.8%(EngelⅠ~Ⅲ)。结论:与无创性视频脑电图相比,利用脑磁图可以对大部分MRI上出现结构性病变的癫痫患者致痫灶进行精确定位,并且能够确定切除区域。
BACKGROUND: Epileptic seizures in most patients with epilepsy can be controlled by pharmacological treatment. However, for patients with refractory epilepsy, surgery may be a therapeutic option. Correctly locating the epileptogenic zone of patients with epilepsy is the basis of successful epilepsy surgery. Preoperative assessment of epilepsy patients include video EEG, MRI, positron emission computed tomography / single photon emission computed tomography and neuropsychological testing. As a new non-invasive preoperative detection, magnetoencephalography has been used in many countries for the study of epilepsy surgery planning and brain function. OBJECTIVE: To evaluate the location of intracranial epileptogenic foci in patients with intractable epilepsy treated by magnetic source imaging before operation. Compared with noninvasive video electroencephalogram (EEG) DESIGN, TIME AND SETTING: The retrospective case analysis was performed at the Brain Magnetics Laboratory of Guangdong Sanjiu Brain Hospital from November 2001 to December 2005. PARTICIPANTS: A total of 618 patients with epilepsy who underwent encephalography were enrolled and their spontaneous magnetic field signals were collected for single dipole localization analysis. Among them, 149 cases had structural changes in MRI examination, and those with history of more than 2 years underwent surgery. The course of disease ranged from 2 to 35 years with an average of 9.5 years. Methods: The brain spontaneous magnetic field was collected in a magnetic shielded room using a 148-channel full-head brain magnetic system (MagnesWH2500, 4-DNeuroimaging, San Diego, CA) with a sampling frequency of 508.63 Hz and a bandpass of 1.0 to 100 Hz. Period of spontaneous brain magnetism, using a single equivalent current dipole for data analysis. The results of the analysis were finally overlaid on the MRI-T1 weighted image to form magnetic source imaging. MAIN OUTCOME MEASURES: Preoperative video EEG, MRI and magnetoencephalography results and postoperative follow-up results. RESULTS: The sensitivities of magnetoencephalography (MAP) to detect significant epileptiform activity during the 30 min interictal period were 91%, and in most patients the equivalent dipoles were mainly located at the margins and adjacent areas of structural abnormalities. Compared with noninvasive video EEG (38.9%, 58/149), most patients with MRI lesions (62.4%, 93/149) were able to locate accurately and determine the resection area by using magnetoencephalography. A total of 89 patients with complete data were followed up for 3 to 35 months with a mean follow-up of 9 months. Seventy of 89 patients (80.9%) did not have epileptic seizures (EngelⅠ); seizures were rare in 7 patients (7.9%) or seizure frequency was reduced by more than 90% (EngelⅡ and EngelⅢ); 10 patients (11.2% ) Had no significant decrease in seizure frequency (Engel IV and Engel V), with a total effective rate of 88.8% (EngelⅠ-Ⅲ). CONCLUSIONS: Compared with noninvasive video EEG, the use of magnetoencephalography can accurately locate the epileptic foci in most patients with epilepsy with structural lesions on MRI and determine the resection area.