中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2009年
35期
6991-6994
,共4页
脑磁图%癫痫%磁源成像%视频脑电图%皮质电图
腦磁圖%癲癇%磁源成像%視頻腦電圖%皮質電圖
뇌자도%전간%자원성상%시빈뇌전도%피질전도
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(Magnes WH2500, 4-D Neuroimaging, San Diego, CA, USA)在磁屏蔽室采集脑自发磁场,采样频率为508.63 Hz,带通为1.0～100 Hz,采集30 min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:30 min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(Engel Ⅱ和 Engel Ⅲ);10例(11.2%)癫痫发作频率无明显减少(Engel Ⅳ和Engel Ⅴ),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.
揹景: 多數癲癇患者的癲癇髮作經藥物治療可得到控製,但對于難治性癲癇患者來說,手術可能是一種治療選擇,正確定位癲癇患者的緻癇竈是癲癇手術成功的基礎.癲癇患者的術前評估包括視頻腦電圖、MRI、正電子髮射計算機體層攝影/單光子髮射計算機體層攝影和神經心理測試等.腦磁圖作為一種新的無創性術前檢測技術,已被許多國傢用于癲癇外科手術計劃和大腦功能的研究.目的:術前採用磁源成像技術進行對手術治療的難治性癲癇患者進行緻癇竈定位,併與無創性視頻腦電圖對比,參攷手術效果,評估其定位價值.設計、時間及地點:迴顧性病例分析,于2001-11/2005-12在廣東三九腦科醫院腦磁圖室完成.對象:選擇進行腦磁圖檢查618例的癲癇患者,採集其自髮磁場信號進行單偶極子定位分析診斷.對其中149例MRI檢查有結構改變、病史在2年以上者進行瞭手術治療,病程2～35年,平均9.5年.方法:用148通道全頭型腦磁繫統(Magnes WH2500, 4-D Neuroimaging, San Diego, CA, USA)在磁屏蔽室採集腦自髮磁場,採樣頻率為508.63 Hz,帶通為1.0～100 Hz,採集30 min髮作間歇期的自髮腦磁,採用單箇等效電流偶極子進行數據分析.分析結果最後重疊在MRI-T1加權像上,形成磁源成像.主要觀察指標:術前視頻腦電圖、MRI和腦磁圖結果及術後隨訪結果.結果:30 min髮作間期的腦磁圖檢測到明顯的癲癇樣活動的敏感度為91%,併且大部分患者,其等效偶極子主要分佈于結構性異常的邊緣和鄰近區域.與無創性視頻腦電圖(38.9%,58/149)相比,利用腦磁圖可以對大部分MRI上有病變的患者(62.4%,93/149)進行精確定位併且能夠確定切除區域.對資料完整的89 例患者進行瞭3～35箇月的隨訪,平均隨訪9箇月.89例患者中有72例(80.9%)術後未齣現癲癇髮作(EngelⅠ);7例(7.9%)癲癇髮作極少或癲癇髮作頻率減少90%以上(Engel Ⅱ和 Engel Ⅲ);10例(11.2%)癲癇髮作頻率無明顯減少(Engel Ⅳ和Engel Ⅴ),總有效率達88.8%(EngelⅠ～Ⅲ).結論:與無創性視頻腦電圖相比,利用腦磁圖可以對大部分MRI上齣現結構性病變的癲癇患者緻癇竈進行精確定位,併且能夠確定切除區域.
배경: 다수전간환자적전간발작경약물치료가득도공제,단대우난치성전간환자래설,수술가능시일충치료선택,정학정위전간환자적치간조시전간수술성공적기출.전간환자적술전평고포괄시빈뇌전도、MRI、정전자발사계산궤체층섭영/단광자발사계산궤체층섭영화신경심리측시등.뇌자도작위일충신적무창성술전검측기술,이피허다국가용우전간외과수술계화화대뇌공능적연구.목적:술전채용자원성상기술진행대수술치료적난치성전간환자진행치간조정위,병여무창성시빈뇌전도대비,삼고수술효과,평고기정위개치.설계、시간급지점:회고성병례분석,우2001-11/2005-12재엄동삼구뇌과의원뇌자도실완성.대상:선택진행뇌자도검사618례적전간환자,채집기자발자장신호진행단우겁자정위분석진단.대기중149례MRI검사유결구개변、병사재2년이상자진행료수술치료,병정2～35년,평균9.5년.방법:용148통도전두형뇌자계통(Magnes WH2500, 4-D Neuroimaging, San Diego, CA, USA)재자병폐실채집뇌자발자장,채양빈솔위508.63 Hz,대통위1.0～100 Hz,채집30 min발작간헐기적자발뇌자,채용단개등효전류우겁자진행수거분석.분석결과최후중첩재MRI-T1가권상상,형성자원성상.주요관찰지표:술전시빈뇌전도、MRI화뇌자도결과급술후수방결과.결과:30 min발작간기적뇌자도검측도명현적전간양활동적민감도위91%,병차대부분환자,기등효우겁자주요분포우결구성이상적변연화린근구역.여무창성시빈뇌전도(38.9%,58/149)상비,이용뇌자도가이대대부분MRI상유병변적환자(62.4%,93/149)진행정학정위병차능구학정절제구역.대자료완정적89 례환자진행료3～35개월적수방,평균수방9개월.89례환자중유72례(80.9%)술후미출현전간발작(EngelⅠ);7례(7.9%)전간발작겁소혹전간발작빈솔감소90%이상(Engel Ⅱ화 Engel Ⅲ);10례(11.2%)전간발작빈솔무명현감소(Engel Ⅳ화Engel Ⅴ),총유효솔체88.8%(EngelⅠ～Ⅲ).결론:여무창성시빈뇌전도상비,이용뇌자도가이대대부분MRI상출현결구성병변적전간환자치간조진행정학정위,병차능구학정절제구역.
BACKGROUND: A considerable number of epilepsy patients cannot be treated sufficiently by drug. Epilepsy surgery is a treatment option in these cases. However, precisely localizing epileptogenic zone in epileptic patients is a successful element of epilepsy surgery. Its goal is to remove a minimum volume to control the seizures without cognitive impairment. Presurgical evaluation typically involves electroencephalogram (EEG), video-EEG monitoring, magnetic resonance imaging (MRI), single photon emission computed tomography and neuropsychological testing. Magnetoencephalography (MEG) has been as a noninvasive technique to be used to epilepsy surgical planning and brain functional study in many countries.OBJECTIVE: To preoperatively localize epileptogenic zone in patients with lesion-associated epilepsy using magnetoencephalography, compare with noninvasive video-EEG, and assess its localizing value according to the surgical outcomes. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Magnetoencephalography Laboratory, Guangdong 999 Brain Hospital, China between November 2001 and December 2005.PARTICIPANTS: A total of 618 epileptic patients undergoing magnetoencephalography. Spontaneous magnetic field signal was collected to analyze single dipole location. Of them, 149 patients with MRI-documented epilepsy underwent surgery. The history of disease was at least 2 years. The course of disease ranged 2-35 years, with an average of 9.5 years. METHODS: MEG was recorded by a 148-channels whole head type MEG system (Magnes WH2500, 4-D Neuroimaging, San Diego, CA, USA) in Magnetically Shielded Room (MSR, Germany). Sampling rate: 508.63 Hz, 30-minutes interictal MEG (Bandpass: 1.0-100 Hz). For magnetic source imaging, the nasion and preauricular points were applied as fiducials. Single equivalent current dipole (ECDs) and head sphere model were applied for analysis. Estimated ECDs were overlaid on T1-weighted MRI of each subject.MAIN OUTCOME MEASURES: Preoperative MEG, MRI, and video-EEG and postoperative follow-up were measured. RESULTS: The sensitivity of the interictal MEG for detecting epileptiform activity was found in 91% of the patient. In most cases, the equivalent dipoles were mainly distributed over the border and neighborhood of the structural lesions. By MEG, we were able to localize the resected region in a greater proportion of patients (62.4%, 93/149) than with noninvasive vedio-EEG (38.9%, 58/149) in all patients with MRI-documented lesions. A total of 89 patients were followed up from 3-35 months, averagely 9 months. Of the 89 patients, 72 patients (80.9%) had no postoperative seizures (EngelⅠ); 7 (7.9%) cases obtain Engel Ⅱ and Engel Ⅲ outcomes. Favorable outcomes were not seen in 10 patients (11.2%) cases (Engel Ⅳ and Engel Ⅴ). Total effective rate was 88.8% (EngelⅠ-Ⅲ). CONCLUSION: MEG is not only most useful for presurgical planning in epilepsy patients with MRI-documented lesions, but is also a noninvasive method to identify the spatial relationship between the lesion and epileptogenic zone, a precise localization of the epileptogenic zone is correlated to a favorable outcome.
