目的:单光子发射计算机断层扫描(SPECT)和立体脑电图(SEEG)是用于治疗耐药局灶性癫痫患者的诊断技术。虽然发作性SPECT研究中的高灌注模式揭示了癫痫发作的发作和传播途径,ictal低灌注的作用仍然知之甚少。这项研究的目的是使用立体EEG记录系统地表征不同灌注的大脑区域之间的时空信息流动力学。
方法:我们确定了切除性癫痫手术后无癫痫发作的患者,这些患者之前进行了SPECT和SEEG检查。我们估计了癫痫发生区(EZ)之间的定向连通性,未切除的过度灌注区域,灌注不足,和间期的基线灌注,预先发作,ictal,和后期。
结果:与背景相比,我们注意到在从EZ到基线和超灌注区域的前期有显著的信息流(1),(2)在从EZ到所有三个区域的发作期间,(3)在癫痫发作从灌注不足区域到所有三个区域的演变期间。
结论:发现低灌注脑区在发作期与EZ间接相互作用。
结论:我们独特的研究,结合颅内电生理和灌注成像,提供了令人信服的证据,表明在从发作间期到发作期状态的过渡过程中,大脑区域之间的方向连通性发生了动态变化。
OBJECTIVE: Ictal Single Photon Emission Computed Tomography (SPECT) and stereo-electroencephalography (SEEG) are diagnostic techniques used for the management of patients with drug-resistant focal epilepsies. While hyperperfusion patterns in ictal SPECT studies reveal seizure onset and propagation pathways, the role of ictal hypoperfusion remains poorly understood. The goal of this study was to systematically characterize the spatio-temporal information flow dynamics between differently perfused brain regions using stereo-EEG recordings.
METHODS: We identified seizure-free patients after resective epilepsy surgery who had prior ictal SPECT and SEEG investigations. We estimated directional connectivity between the epileptogenic-zone (EZ), non-resected areas of hyperperfusion, hypoperfusion, and baseline perfusion during the interictal, preictal, ictal, and postictal periods.
RESULTS: Compared to the background, we noted significant information flow (1) during the preictal period from the EZ to the baseline and hyperperfused regions, (2) during the ictal onset from the EZ to all three regions, and (3) during the period of seizure evolution from the area of hypoperfusion to all three regions.
CONCLUSIONS: Hypoperfused brain regions were found to indirectly interact with the EZ during the ictal period.
CONCLUSIONS: Our unique study, combining intracranial electrophysiology and perfusion imaging, presents compelling evidence of dynamic changes in directional connectivity between brain regions during the transition from interictal to ictal states.