联合磁源性影像和磁共振波谱技术评估颞叶癫痫的价值

目的：探讨磁源性成像（MSI）和磁共振波谱（^1H—MRS）技术结合在颞叶癫痫诊断定位中的价值。方法：设健康对照者10例，特发颞叶癫痫患者8例，应用MEG定位痫性病灶，选取MEG异常区域、对侧相应区域和双颞叶内侧区域测量NAA／Cho值，并观察是否存在海马硬化。结果：8例患者MEG检查结果均异常，6例MEG异常相应区域MRS检查NAA／Cho值减少，符合率为62．5％；MRI显示海马硬化2例，MRI正常6例，颞叶内侧MRS扫描未见明显改变。结论：联合MSI和MRS技术可进一步提高颞叶癫痫致痫灶的定位准确性。     

Epilepsy surgery, resection volume and MSI localization in lesional frontal lobe epilepsy

To verify whether interictal noninvasive information detected by magnetoencephalography (MEG) recordings can contribute to localize focal epileptic activity relevant for seizure generation in lesional frontal lobe epilepsy, magnetic source imaging (MSI) localizations of epileptic discharges were compared to the extent of neurosurgical resection and postoperative outcome. Preoperative MEG spike localizations were displayed in postoperative magnetic resonance imaging (MRI) scans to check whether dipole sites were located within the resection cavity. Moreover, MEG localizations were compared with results of prolonged video-EEG monitoring and, in three cases, with invasive EEG recordings. Our results in five cases with lesional frontal lobe epilepsy showed that good surgical outcome could be achieved in those patients where the majority of MEG spike localizations were located within the resected brain volume.     

Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings

To compare magnetoencephalography (MEG) with scalp electroencephalography (EEG) in the detection of interictal spikes in temporal lobe epilepsy (TLE), we simultaneously recorded MEG and scalp EEG with a whole-scalp neuromagnetometer in 46 TLE patients. We visually searched interictal spikes on MEG and EEG channels and classified them into three types according to their presentation on MEG alone (M-spikes), EEG alone (E-spikes), or concomitantly on both modalities (M/E-spikes). The M-spikes and M/E-spikes were localized with MEG equivalent current dipole modeling. We analyzed the relative contribution of MEG and EEG in the overall yield of spike detection and also compared M-spikes with M/E-spikes in terms of dipole locations and strengths. During the 30- to 40-min MEG recordings, interictal spikes were obtained in 36 (78.3%) of the 46 patients. Among the 36 patients, most spikes were M/E-spikes (68.3%), some were M-spikes (22.1%), and some were E-spikes (9.7%). In comparison with EEG, MEG gave better spike yield in patients with lateral TLE. Sources of M/E- and M-spikes were situated in the same anatomical regions, whereas the average dipole strength was larger for M/E- than M-spikes. In conclusion, some interictal spikes appeared selectively on either MEG or EEG channels in TLE patients although more spikes were simultaneously identified on both modalities. Thus, simultaneous MEG and EEG recordings help to enhance spike detection. Identification of M-spikes would offer important localization of irritative foci, especially in patients with lateral TLE.     

Localization of abnormal discharges causing insular epilepsy by magnetoencephalography

The insula, one of the five cerebral lobes of the brain, is located deep within the brain and lies mainly beneath the temporal lobe. Insular epilepsy can be easily confused and misdiagnosed as temporal lobe epilepsy (TLE) because of the similar clinical symptoms and scalp electroencephalography (EEG) findings due to the insula location and neuronal connections with the temporal lobe. Magnetoencephalography (MEG) has higher sensitivity and spatial resolution than scalp EEG, and thus can often identify epileptic discharges not revealed by scalp EEG. Simultaneous scalp EEG and MEG were performed to detect and localize epileptic discharges in two patients known to have insular epilepsy associated with cavernous angioma in the insula. Epileptic discharges were detected as abnormal spikes in the EEG and MEG findings. In Patient 1, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe, similar to TLE. In contrast, the sources of all MEG spikes detected only by MEG (M-spikes) were adjacent to the insular lesion. In Patient 2, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe. These findings indicate that MEG allows us to detect insular activity that is undetectable by scalp EEG. In conclusion, simultaneous EEG and MEG are helpful for detecting spikes and obtaining additional information about the epileptic origin and propagation in patients with insular epilepsy.     

Three-dimensional neuroimaging in diagnosis and surgical treatment for epilepsy

Development of functional neuroimaging is contributed to diagnosis and treatment in epilepsy patients. The dipole analysis of interictal spikes on EEG or MEG provides 3D-localization of the irritable zone. Interictal and ictal CBF-SPECT reveals the local change in CBF associated to epileptic focus. Three-dimensional stereotactic surface projection (3D-SSP) of SPECT is useful to recognize the seizure generation area. Furthermore, Subtraction ictal SPECT coregistration of MRI (SISCOM), that is fusion image of anatomical and functional brain images, is beneficial to understand the localization of seizure-induced hyperperfusion area. During epilepsy surgery, image-guided system makes less-invasive and accurate surgery possible. Functional image-guided surgery for epilepsy will be available in near future.     

联合脑电功能MRI观察颞叶癫痫脑活动局域的一致性改变

目的 探讨颞叶癫痫患者功能MRI(fMRI)局域一致性(ReHo)改变的癫痫电活动基础。方法 对6例单侧颞叶癫痫患者行同步脑电图(EEG)-fMRI。另选取正常对照21名,采集fMRI数据。所有fMRI数据经处理后被分为42小段,分析每小段数据的ReHo值与该段数据时间内间期痫样发放次数的相关性。结果 与正常对照相比,mTLE患者右侧海马区域、右侧颞叶及双侧顶叶ReHo值明显增高。体素依赖分析结果显示,癫痫侧的内侧颞叶、丘脑及脑干等部位ReHo值与间期痫样发放次数呈正相关,其中内侧颞叶处相关性较高(r=0.36, P<0.02)。结论 癫痫电活动发放是ReHo值升高的主要生理基础,为基于ReHo分析的fMRI在癫痫活动检测方面的应用提供了生物学证据。     

Cerebral perfusion changes in mesial temporal lobe epilepsy: SPM analysis of ictal and interictal SPECT

We examined cerebral perfusion changes in mesial temporal lobe epilepsy (mTLE) by the statistical parametric mapping of brain single photon emission computed tomography (SPECT) images of 38 mTLE patients and 19 normal controls. Ictal and interictal SPECTs were compared with control SPECTs by independent t test, and ictal and interictal SPECTs by paired t test. We evaluated the number of heterotopic neurons in temporal lobe white matter, white matter changes of the anterior temporal lobe (WCAT) and ictal hyperperfusion of the temporal stem (IHTS). Left mTLE showed interictal hypoperfusion in the ipsilateral hippocampus, bilateral thalami, and paracentral lobules. Right mTLE showed hypoperfusion in bilateral hippocampi, contralateral insula, bilateral thalami, and paracentral lobules. Both mTLEs showed ictal hyperperfusion in bilateral temporal lobes with ipsilateral predominance, and in the anterior frontal white matter bilaterally. By paired t test, ictal hyperperfusion was found in the ipsilateral temporal lobe, temporal stem, hippocampus, thalamus, putamen, insula, and bilateral precentral gyri, whereas ictal hypoperfusion was found in bilateral frontal poles and middle frontal gyri. Fifteen patients showed WCAT and 19 showed IHTS, a weak correlation was observed between WCAT and IHTS (r = 0.377, P = 0.02). WCAT was found to correlate with an early seizure onset age. In 35 patients, heterotopic neurons were found in the white matter of the resected temporal lobe, but the number of heterotopic neurons did not correlate with WCAT or IHTS. In summary, the cerebral perfusion patterns of mTLE suggest interictal hypofunction and ictal activation of the cortico-thalamo-hippocampal-insular network and ictal hypoperfusion of the anterior frontal cortex.     

单侧海马硬化颞叶癫痫患者头皮脑电图发作间期棘波频率与手术疗效的关系

目的:评估单侧海马硬化的颞叶癫痫患者头皮脑电图发作间期棘波(interictal spike,IEDs)频率与手术疗效的关系。方法:回顾性分析33例单侧海马硬化的颞叶癫痫患者头皮脑电图,随机抽取手术前1h清醒期脑电图分析其IEDs频率和分布,并据此将患者分为2类:(1)IEDs高频组和IEDs低频组;(2)IEDs单侧颞叶组和IEDs双侧颞叶组。患者经1年以上随访统计预后。用Fisher确切检验法、广义线性模型分析IEDs频率与手术疗效的关系。结果:IEDs低频组17例,其中16例(94.1%)术后发作消失;IEDs高频组16例,其中10例(62.5%)术后发作消失,两组间疗效差异存在显著性(P=0.039)。患者先兆和全面性发作的存在、病程与患者IEDs频率正相关。结论:单侧海马硬化颞叶癫痫患者清醒期IEDs频率高预示手术疗效不良。     

Usefulness of MEG magnetometer for spike detection in patients with mesial temporal epileptic focus

The present study investigated the sensitivity of magnetoencephalography (MEG) for spikes depending on sensor type in patients with mesial temporal epileptic focus. We recorded MEG in 6 patients with mesial temporal epileptic focus using two sensor types (magnetometer and gradiometer) simultaneously. The number of spikes detected and the corresponding equivalent current dipole (ECD) parameters (distance from the coordinated head center (radius), and dipole moment) were evaluated with respect to sensor type. Among 426 MEG 'consensus spikes' determined by 3 reviewers, 378 spikes satisfied the predetermined criteria for source localization. Comparing ECD parameters, spikes detected by magnetometer alone displayed a smaller radius and larger dipole moment than those detected by gradiometer alone. Spikes estimated in the mesial temporal area were more frequently detected by magnetometer alone (38.5%) than by gradiometer alone (11.5%), whereas spikes in the lateral temporal area were detected less by magnetometer alone (3.7%) than by gradiometer alone (53.9%). The present results suggest that a magnetometer is advantageous for spike detection in patients with mesial temporal epileptic focus. This also implies the higher sensitivity of magnetometer for deep sources.     

Simultaneous Recording of Epileptiform Discharges by MEG and Subdural Electrodes in Temporal Lobe Epilepsy

Spontaneous epileptiform discharges were recorded by whole head magnetoencephalography (MEG) and subdural electrodes simultaneously from two patients with medically intractable temporal lobe epilepsy. In one patient whose epileptiform discharges emerged from the lateral temporal lobe, simultaneously recorded MEG could estimate equivalent current dipole reliably near the tumor. The amplitude of the dipole was in proportion not only to the amplitude of epileptiform discharge but also to the number of subdural electrodes involved. In the other patient, MEG detected only a small proportion of epileptiform discharges, even when they were recorded by subdural electrodes from the mesial temporal lobe. It is concluded that the amplitude and the depth of epileptiform discharges would largely affect the sensitivity of dipole localization by MEG.     

Correlations of interictal FDG-PET metabolism and ictal SPECT perfusion changes in human temporal lobe epilepsy with hippocampal sclerosis

BACKGROUND: The pathophysiological role of the extensive interictal cerebral hypometabolism in complex partial seizures (CPS) in refractory mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) is poorly understood. Our aim was to study ictal-interictal SPECT perfusion versus interictal fluorodeoxyglucose (FDG)-PET metabolic patterns. METHODS: Eleven adults with refractory unilateral mTLE-HS, who were rendered seizure free after epilepsy surgery, were included. All had an interictal FDG-PET and an interictal and ictal perfusion SPECT scan. FDG-PET data were reconstructed using an anatomy-based reconstruction algorithm, which corrected for partial volume effects, and analyzed semi-quantitatively after normalization to white matter activity. Using Statistical Parametric Mapping (SPM), we compared interictal metabolism of the patient group with a control group. We correlated metabolic with ictal perfusion changes in the patient group. RESULTS: Global cerebral grey matter glucose metabolism in patients was decreased 10-25% compared with control subjects. Interictal PET hypometabolism and ictal SPECT hypoperfusion were maximal in the ipsilateral frontal lobe. Ictal frontal lobe hypoperfusion was associated with crossed cerebellar diaschisis. The ipsilateral temporal lobe showed maximal ictal hyperperfusion and interictal hypometabolism, which was relatively mild compared with the degree of hypometabolism affecting the frontal lobes. CONCLUSION: Interictal hypometabolism in mTLE-HS was greatest in the ipsilateral frontal lobe and represented a seizure-related dynamic process in view of further ictal decreases. Crossed cerebellar diaschisis suggested that there is a strong ipsilateral frontal lobe inhibition during CPS. We speculate that surround inhibition in the frontal lobe is a dynamic defense mechanism against seizure propagation, and may be responsible for functional deficits observed in mTLE.     

Correspondence between EEG-fMRI and EEG dipole localisation of interictal discharges in focal epilepsy

EEG-fMRI and EEG dipole source localisation are two non-invasive imaging methods that can be applied to the study of the haemodynamic and electrical consequences of epileptic discharges. Using them in combination has the potential to allow imaging with the spatial resolution of fMRI and the temporal resolution of EEG. However, although considerable data are available concerning their concordance in studies involving event-related potentials (ERPs), less is known about how well they agree in epilepsy. To this end, 17 patients were selected from a database of 57 who had undergone an EEG-fMRI scanning session followed by a separate EEG session outside of the scanner. Spatiotemporal dipole modelling was compared with the peak and closest EEG-fMRI activations and deactivations. On average, the dipoles were 58.5 mm from the voxel with the highest positive t value and 32.5 mm from the nearest activated voxel. For deactivations, the corresponding values were 60.8 and 34.0 mm. These values are considerably higher than is generally observed with ERPs, probably as a result of the relatively widespread field, which can lead to artificially deep dipoles, and the occurrence of EEG-fMRI responses remote from the presumed focus of the epileptic activity. The results suggest that EEG and MEG inverse solutions for equivalent current dipole approaches should not be strongly constrained by EEG-fMRI results in epilepsy, and that the use of distributed source modelling will be a more appropriate way of combining EEG-fMRI results with source localisation techniques.     

应用FAIR技术评价难治性和非难治性颞叶癫痫灌注异常

目的用FAIR技术评价难治性及非难治性颞叶癫痫患者发作间期rCBF异常的模式是否不同.方法 9例难治性颞叶癫痫、21例非难治性颞叶癫痫患者及13名正常志愿者,测量其双侧大脑半球及双侧内侧颞叶的rCBF,并计算不对称指数(AI).结果难治性及非难治性癫痫患者大脑半球AI值与正常对照组之间有统计学差异(P值分别为0.012和0.029);难治性颞叶癫痫患者内侧颞叶AI值与正常对照组之间无统计学差异(P＝0.102),而非难治性癫痫患者与正常对照组之间有统计学差异(P＝0.049).结论难治性和非难治性颞叶癫痫患者发作间期rCBF异常的模式有所不同,虽然均可出现较广泛的rCBF异常,但难治性癫痫更倾向于出现双侧内侧颞叶低灌注,这可为判断预后提供帮助.     

Panic attack symptoms in a patient with left temporal lobe epilepsy

We describe a 56-year-old woman with left temporal lobe epilepsy who developed symptoms of a panic attack. Owing to normal electroencephalography and brain magnetic resonance imaging results, she was initially diagnosed as suffering from panic attacks and treated for anxiety neurosis. The symptoms persisted and she was re-examined in our department. An interictal electroencephalogram showed paroxysmal spike waves in the left mesial temporal lobe region and this was the basis for a diagnosis of left temporal lobe epilepsy. This report suggests that left temporal lobe epilepsy should be considered as the differential diagnosis when patients frequently complain of fear or anxiety.     

Source analysis of interictal spikes in polymicrogyria: loss of relevant cortical fissures requires simultaneous EEG to avoid MEG misinterpretation

PURPOSE: Multiple source analysis of interictal EEG and MEG spikes was used to identify irritative zones in polymicrogyria (PMG). Spike onset times and source localization were compared between both modalities. PMG is characterized by a marked loss of deep cortical fissures. Hence, differences between EEG and MEG were expected since MEG signals are predominantly generated from tangentially orientated neurons in fissures. PATIENTS: We studied 7 children and young adults (age 7.5 to 19 years) with localization-related epilepsy and unilateral polymicrogyria (PMG) as defined from anatomical MRI. METHODS: 122-channel whole-head MEG and 32-channel EEG were recorded simultaneously for 25 to 40 min. Using the BESA program, interictal spikes were identified visually and used as templates to search for similar spatio-temporal spike patterns throughout the recording. Detected similar spikes (r > 0.85) were averaged, high-pass filtered (5 Hz) to enhance spike onset, and subjected to multiple spatio-temporal source analysis. Source localization was visualized by superposition on T1-weighted MRI and compared to the lesion. RESULTS: Nine spike types were identified in seven patients (2 types in 2 patients). Eight out of nine EEG sources and seven MEG sources modeling spike onset were localized within the visible lesion. EEG spike onset preceded MEG significantly in two spike types by 19 and 25 ms. This was related to radial onset activity in EEG while MEG localized propagated activity. In one case, the earliest MEG spike activity was localized to the normal hemisphere while the preceding radial EEG onset activity was localized within the lesion. Distances between EEG and MEG onset sources varied markedly between 9 and 51 mm in the eight spike types with concordant lateralization. CONCLUSION: Interictal irritative zones were localized within the lesion in PMG comparable to other malformations, e.g., FCD. Discrepancies in MEG and EEG were related to the lack of deep fissures in PMG. In two cases, MEG was blind to the onset of radial interictal spike activity and localized propagated spike activity. In two other cases, MEG localized to the more peripheral parts of the irritative zone. Simultaneous EEG recordings with MEG and multiple source analysis are required to avoid problems of MEG interpretation.     

Autonomic epilepsy--the influence of epileptic discharges on heart rate and rhythm.

PURPOSE: To study cardiac alterations (changes in heart rate and cardiac arrhythmias) at the transition from the pre-ictal to the ictal state during focal epileptic seizures. METHODS: We assessed ECG changes during 92 seizures recorded with scalp EEG in 30 patients and 35 seizures in 11 patients evaluated with subdural strip and/or grid electrodes. Consecutive RR intervals were analyzed with a newly developed mathematical model for a total of 90 seconds (60 seconds pre-ictal, 30 seconds ictal). RESULTS: We found an ictal tachycardia (heart rate increase > 10 bpm) in 82.5% of seizures, and an ictal bradycardia (heart rate decrease > 10 bpm) in 3.3% of seizures. Bradycardia was only observed in seizures of frontal lobe origin. Heart rate changes occurred several seconds prior to EEG seizure onset on scalp-EEG in 76.1% of seizures, but also prior to EEG seizure onset on invasive EEG in 45.7% of seizures. Early tachycardia occurred significantly more often in temporal than in frontal lobe origin seizures. We found no significant effect of the side of seizure onset on both the quality and quantity of ictal heart rate changes. The occurrence of an aura or of awakening prior to the seizure had no influence on peri-ictal heart rate changes. Low risk cardiac arrhythmias were more frequently observed in frontal lobe origin seizures. CONCLUSIONS: Epileptic discharges directly influence portions of the central autonomic network, within a brain area too small or too deep to be detected on EEG, most likely deep mesial structures such as the amygdala or portions of the hippocampus. The potential clinical applications of our results include (1) automatic seizure detection, (2) differentiation between seizures of temporal and frontal lobe origin, (3) detection of peri-ictal cardiac arrhythmias, and (4) clarification of SUDS (sudden unexplained death syndrome) in epilepsy.     

BOLD correlates of continuously fluctuating epileptic activity isolated by independent component analysis

Combined EEG/fMRI recordings offer a promising opportunity to detect brain areas with altered BOLD signal during interictal epileptic discharges (IEDs). These areas are likely to represent the irritative zone, which is itself a reflection of the epileptogenic zone. This paper reports on the imaging findings using independent component analysis (ICA) to continuously quantify epileptiform activity in simultaneously acquired EEG and fMRI. Using ICA derived factors coding for the epileptic activity takes into account that epileptic activity is continuously fluctuating with each spike differing in amplitude, duration and maybe topography, including subthreshold epileptic activity besides clear IEDs and may thus increase the sensitivity and statistical power of combined EEG/fMRI in epilepsy. Twenty patients with different types of focal and generalized epilepsy syndromes were investigated. ICA separated epileptiform activity from normal physiological brain activity and artifacts. In 16/20 patients, BOLD correlates of epileptic activity matched the EEG sources, the clinical semiology, and, if present, the structural lesions. In clinically equivocal cases, the BOLD correlates aided to attribute proper diagnosis of the underlying epilepsy syndrome. Furthermore, in one patient with temporal lobe epilepsy, BOLD correlates of rhythmic delta activity could be employed to delineate the affected hippocampus. Compared to BOLD correlates of manually identified IEDs, the sensitivity was improved from 50% (10/20) to 80%. The ICA EEG/fMRI approach is a safe, non-invasive and easily applicable technique, which can be used to identify regions with altered hemodynamic effects related to IEDs as well as intermittent rhythmic discharges in different types of epilepsy.     

脑磁图与视频脑电图定位癫痫灶的结果比较

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.     

发作间期PET显像与发作期SPECT脑显像在小儿顽固性癫痫定位诊断中的价值

目的:探讨发作间期FDG PET与发作期SPECT脑显像在小儿顽固性癫痫定位诊断中的价值。方法:对30例小儿顽固性癫痫患者行发作间期FDG PET与发作期SPECT显像,并对结果进行对比分析。结果:16例发作间期PET表现为局限性单叶代谢减低,14例表现为多灶或弥漫性改变。发作期SPECT显像18例为单叶局限性高灌注,10例为多处高灌注灶。30例患者中26例(86.7%)两项检查结果相符合,12例PET发作间期呈多病灶或弥漫性改变者,6例于发作期转化为单叶局限性病灶。结论:发作期SPECT结合发作间期PET显像,两者联合应用优势互补,可提高癫痫定位的准确性,为进一步治疗提供更可靠的信息。     

18F-FDG PET显像与EEG在颞叶癫痫致痫灶定位价值上的对比研究

目的：通过对62例难治性癫痫患者进行前瞻性研究,对18F-FDG PET显像与EEG在颞叶癫痫致痫灶定位上的价值进行对比研究。方法：对62例临床确诊颞叶癫痫并接受手术治疗的患者进行前瞻性研究。所有患者均进行发作间期PET-CT脑显像检查和长程/视频EEG检查,细致分析图像,并将所得检查结果与术后病理进行比较,利用统计学方法对二者的诊断准确率进行对比分析。结果：18F-FDG PET显像准确定位42例癫痫患者病灶位置,头皮EEG准确定位致痫灶30例,准确率分别为67.7%及48.4%,二者比较有显著统计学差异（P<0.05）。18F-FDG PET显像结果表现较多样,影像分析应细致、审慎。结论：发作间期PET-CT脑显像检查定位颞叶癫痫致痫灶优于长程/视频EEG检查,但因其价格较昂贵,临床可首选EEG定位癫痫,EEG定位困难时选择PET显像可明显提高致痫灶定位准确性。