难治性癫痫致病灶术前定位 EEG 联合 fMRI 检查的临床研究

摘要

目的：探讨对难治性癫痫患者术前进行EEG联合fM RI检查确定癫痫致病灶的准确性。方法选取行外科手术的难治性癫痫患者23例为研究对象，患者佩戴能在高场强M R室中使用的EEG高级电极帽，在M R扫描的同时采集EEG数据，记录棘波发生时间，并根据棘波的发放时间输入信号曲线，找出f M RI数据，求f M RI数据体与该曲线的相应关系，将相应程度高的区域（激活区）叠加在M RI的三维图像上，从而对癫痫致病灶进行定位。将该致病灶的位置、范围与手术中脑皮质电极及深部电极中显示的致痫灶进行比较。结果13例（56.52％） EEG联合fM RI检查显示的癫痫致病灶与术中通过皮质电极及深部电极EEG所描记、确定的致病灶位置和范围完全相同。另外10例（43.48％）EEG联合fM RI检查显示的癫痫致病灶与术中通过皮质电极及深部电极EEG所描记、确定的致病灶位置相同，但是范围明显大于术中所确定的致病灶范围；对患者出院后进行随访6个月以上，其中15例（65.22％）癫痫未再发作，5例（14.29％）术后3周内出现癫痫发作1～4次，给予抗癫痫药物治疗后得到控制，3例（13.04％）仍有发作，给予药物控制后仍无法控制，但发作频率为每月（3.1±1.4）次，较术前发作次数明显降低。结论对难治性癫痫患者术前进行EEG联合fM RI检查定位致病灶，其定位准确，时间及空间分辨率均较高且是无创性的。%Objective To investigate the accuracy of EEG combined with fMRI examination in preoperative localization in refractory epileps.Methods We selected 23 cases with refractory epilepsy ,all with advanced EEG electrode cap worn which can be used in high‐field MR room. EEG data were collected while the MR scan and spike occurring time were recorded ,ente‐ring the time of signal curve according to the spikes occurring time. Then we found the fMRI data and identified the corre‐sponding relationship between the fMRI data and the fMRI data of the signal curve ,superposing the corresponding high degree of region (active region) on MRI three‐dimensional images ,thus locating the epilepsy lesion. And we compared the lesions caused by the position of the scope with the cerebral cortex electrodes and depth electrodes shown during the operations. Results The epilepsy lesions in 13 cases (56.52% ) and extent of the lesion located by EEG combined fMRI examination showed the exactly same with epilepsy lesions caused by the tracings with intraoperative cortical electrodes and through deep electrode EEG. Other 10 (43.48% ) patients’ epilepsy lesions located by EEG combined fMRI examination showed the same with epilep‐sy lesions caused by the tracings with intraoperative cortical electrodes and through deep electrode EEG ,but the scope located by which was significantly larger than that by intra‐operative determined ;we followed up for more than 6 months after the pa‐tient discharged. 15 patients (65.22% ) had no further epileptic seizures ,5 cases (14.29% ) with seizure occurred one to four times in 3 weeks and got controlled after given antiepileptic drug ,3 cases (13.04% ) still attacked and couldn’t get controlled after given medications ,but seizure frequency was (3.1 ± 1.4) times per month ,which was significantly reduced compared with preoperative episodes. Conclusion Preoperative localization in refractory epilepsy examined by EEG combined with fMRI is accurate with high time and spatial resolution ,furthermore ,it is noninvasive.