High-density EEG

高密度脑电图
  • 文章类型: Case Reports
    癫痫手术是儿童耐药癫痫(DRE)最有效的治疗方法。神经外科的最新进展,如激光间质热疗法(LITT),提高了该方法的安全性和非侵入性。在DRE患儿的术前评估中,电和磁源成像(ESI/MSI)在癫痫灶的描绘中起着至关重要的作用。然而,即使在三级癫痫中心,它们目前也未得到充分利用。这里,我们介绍一例青少年患有DRE16年,在Cook儿童医疗中心(CCMC)接受手术治疗.先前在4级癫痫中心对患者进行了评估,并使用多种抗癫痫药物治疗了数年。CCMC的术前评估包括长期视频脑电图(EEG),脑磁图(MEG)在两个连续会话中同时进行常规EEG(19通道)和高密度EEG(256通道),MRI,和氟脱氧葡萄糖-正电子发射断层扫描(FDG-PET)。视频长期EEG捕获了9个局灶性发作的临床癫痫发作,在右额叶/额叶中线区域具有最大的演变。MRI最初被解释为非病灶。FDG-PET显示右前颞上回的小区域代谢不足。用偶极子聚类进行的ESI和MSI显示右前脑岛中的偶极子紧密簇。患者进行了颅内脑电图检查,提示右前岛叶为癫痫发作发作区。最终,LITT使患者无癫痫发作(Engel1;手术后12个月)。对ESI和MSI簇状偶极子的回顾性分析发现,偶极子与消融体积的平均距离为10至25mm。我们的发现强调了最近的技术进步在DRE儿童的术前评估和手术治疗中的重要性。以及DRE患儿对癫痫手术的利用不足。
    Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children\'s Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.
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