磁源性影像在灰质异位症伴癫痫患者癫痫灶定位中的应用

目的 探讨磁源性影像(MSI)对灰质异位症(GMH)伴发癫痫患者的癫痫灶定位价值.方法 8例GMH伴发癫痫的患者进行MSI检查,数据采集后进行后处理,观察癫痫灶的位置,并与皮质脑电图(ECoG)比较.影像检查后,所有患者均进行手术治疗,手术后随访13～48个月,观察手术效果.结果 8例患者病理均为灰质异位,其中1例病理结果伴有海马硬化,2例伴有局灶性脑皮质发育不良(FCD)Ⅰ b型,1例伴有FCDⅡb型.8例患者中,MRI显示:结节型灰质异位2例,其中1例伴有脑裂畸形;皮质下型4例;MRI显示正常2例.MSI确定癫痫灶位于右颞叶2例,左额叶2例,双顶叶、左顶叶、左颞叶、左额顶叶各1例.MSI所确定的癫痫灶中,4例患者癫痫灶与异位灰质完全重叠,1例癫痫灶紧邻异位灰质后方,1例癫痫灶与异位灰质部分重叠并且癫痫灶范围明显大于异位灰质,1例患者有2个癫痫灶,分别位于异位灰质及异位灰质前方2 cm,1例患者癫痫灶位于异位灰质后外侧2 cm.8例患者MSI癫痫灶定位与术中ECoG定位完全一致.按Engel癫痫疗效分级,术后6例为Engel Ⅰ级,均为发作停止;2例为EngelⅣ级,手术前后癫痫发作频率无明显变化.结论 MSI可提示灰质异位伴发癫痫患者的癫痫灶定位,是术前无创伤定位的有效手段.

Abstract：

Objective To evaluate the value of magnetic source imaging(MSI) in localizing the epileptic foci of patients with histologically proved grey matter heterotopia(GMH) and seizure. Methods MSI examinations were performed on 8 patients with GMH and seizure. The location of the epileptic foci defined by MSI was compared with the results of the ECoG. After imaging examinations, all patients received operation with 13-48 months follow up to observe the effectiveness of the operation. Results Among the 8 patients, 1 had hippocampal sclerosis,2 had focal cortical dysplasiaof type Ⅰ B and 1 had focal cortical dysplasia of type Ⅱ B. MRI showed normal findings in 2 cases, subcortical heterotopia in 4 cases, and nodulor heterotopia in 2 cases with one having schizencephaly. The epileptic foci defined by MSI were at right temporal lobe in 2 cases, left frontal lobe in 2 cases, biparietal lobe in1 case, left parietal lobe in 1 case, left temporal lobe in 1 case, and left frontal-parietal lobe in 1 case. The epileptic foci defined by MSI were completely overlaid with area of GMH in 4 cases, closely behind the area of GMH in case, and partly overlaid with area of GMH in 1 cases with size larger than that of the latter. One patient showed two epileptic foci with one located within the area of GMH and the other one 2 centimeters anterior to the area of GMH.One case's epileptic focus located 2 centimeters posteolateral to the area of GMH . The locations of the epileptic foci defined by MSI showed no difference with those defined by ECoG in all patients. According to Engel classification of treatment effect of epilepsy, 6 patients achieved Engle class Ⅰ ( seizure free after operation ), and 2 patients Engel class Ⅳ ( no changes in the frequcenty of occurrence of seizures before and after operation ). Conclusion MSI can noninvasively and precisely localize the epileptic foci before operation in patients with GMH and seizure.

Application of magnetic source imaging in localizing the epileptic foci in patients with grey matter heterotopia

Objective To evaluate the value of magnetic source imaging(MSI) in localizing the epileptic foci of patients with histologically proved grey matter heterotopia(GMH) and seizure. Methods MSI examinations were performed on 8 patients with GMH and seizure. The location of the epileptic foci defined by MSI was compared with the results of the ECoG. After imaging examinations, all patients received operation with 13-48 months follow up to observe the effectiveness of the operation. Results Among the 8 patients, 1 had hippocampal sclerosis,2 had focal cortical dysplasiaof type Ⅰ B and 1 had focal cortical dysplasia of type Ⅱ B. MRI showed normal findings in 2 cases, subcortical heterotopia in 4 cases, and nodulor heterotopia in 2 cases with one having schizencephaly. The epileptic foci defined by MSI were at right temporal lobe in 2 cases, left frontal lobe in 2 cases, biparietal lobe in1 case, left parietal lobe in 1 case, left temporal lobe in 1 case, and left frontal-parietal lobe in 1 case. The epileptic foci defined by MSI were completely overlaid with area of GMH in 4 cases, closely behind the area of GMH in case, and partly overlaid with area of GMH in 1 cases with size larger than that of the latter. One patient showed two epileptic foci with one located within the area of GMH and the other one 2 centimeters anterior to the area of GMH.One case's epileptic focus located 2 centimeters posteolateral to the area of GMH . The locations of the epileptic foci defined by MSI showed no difference with those defined by ECoG in all patients. According to Engel classification of treatment effect of epilepsy, 6 patients achieved Engle class Ⅰ ( seizure free after operation ), and 2 patients Engel class Ⅳ ( no changes in the frequcenty of occurrence of seizures before and after operation ). Conclusion MSI can noninvasively and precisely localize the epileptic foci before operation in patients with GMH and seizure.