脑磁图与头皮视频脑电图在颞叶癫痫的应用比较

目的比较脑磁图与头皮视频脑电图（VEEG）对癫痫灶定位的应用前景。方法对69例癫痫患者进行手术治疗,术前均通过VEEG、脑磁图检查,进行两者在定侧、定叶诊断的对比研究。手术在VEEG及脑深部脑电图监测下进行,手术治疗结果以Engel疗效分级评价。结果69例患者中MEG定位局限于单个叶的为62例,VEEG仅为30例。脑磁图比术前VEEG检查有定侧意义,二者之间的差异有统计学意义（χ^2=30．250,P=0．000）。36例术前VEEG表现为双侧或者全导癫痫波的颞叶癫痫患者,其中有34例脑磁图表现为单侧癫痫波,具有定侧诊断的意义。结论综合比较脑磁图比VEEG对难治性颞叶癫痫患者的定位准确性高。脑磁图空间分辨率、时间分辨率高,可以有助于区分致痫灶和镜灶。

The application of magnetoencephalography versus scalp electroencephalography in intractable temporal lobe epilepsy

OBJECTIVE: To explore the clinical application value and feasibility of magnetoencephalography (MEG) in the localization of epileptogenic zone, as compared with scalp electroencephalography. METHODS: 69 patients were enrolled in this study, all the patients were examined with MEG and scalp EEG and received operative treatment. During the operation the patients underwent ECoG and deep EEG monitoring and after the operation the follow-up continued 2 - 3 years. Results were evaluated with Engel curative effect grading. RESULTS: Among the 69 patients there was 62 patients whose localization were limited to one lobe with MEG; while only 30 with EEG. We used Engels, grading to define the effectiveness of the operation. 57 among the 69 patients had effective results with an effective rate of 82.61%. When the lateralization of epileptogenic zone in these 57 patients was counted, the concordance rate of preoperative MEG and EEG with intraoperative EEG was 92.98% (53/57) and 33.33% (19/57) respectively with significant difference between MEG and EEG statistically (chi(2) = 30.250, P = 0.000). The scalp EEG of 34 patients with temporal lobe epilepsy showed bilateral temporal lobe epileptiform discharges or generalized spikes, while the epileptogenic foci were shown with MEG only unilaterally and confirmed by operation finally. CONCLUSIONS: MEG shows significant value in the lateralization of epileptogenic zone of temporal lobe epilepsy. MEG, with a higher time resolution and space resolution, can help to identify epileptogenic zone and mirror foci. MEG can clarify the spatial relationship between the irritative zone and structural lesions or functional areas.