Multimodality imaging in the surgical treatment of children with nonlesional epilepsy

被引：93

作者：

Seo, J. H. ^{[1
]}

Holland, K. ^{[1
]}

Rose, D. ^{[1
]}

Rozhkov, L. ^{[1
]}

Fujiwara, H. ^{[1
]}

Byars, A. ^{[1
]}

Arthur, T. ^{[1
]}

DeGrauw, T. ^{[1
]}

Leach, J. L. ^{[2
]}

Gelfand, M. J. ^{[2
]}

Miles, L. ^{[3
]}

Mangano, F. T. ^{[4
]}

Horn, P. ^{[1
,5
]}

Lee, K. H. ^{[1
]}

机构：

[1] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Pediat Neurol, Cincinnati, OH 45229 USA

[2] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Dept Radiol, Cincinnati, OH 45229 USA

[3] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Dept Pathol, Cincinnati, OH 45229 USA

[4] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Pediat Neurosurg, Cincinnati, OH 45229 USA

[5] Univ Cincinnati, Dept Math Sci, Cincinnati, OH 45229 USA

来源：

NEUROLOGY | 2011年 / 76卷 / 01期

关键词：

TEMPORAL-LOBE EPILEPSY; EXTRATEMPORAL EPILEPSY; NEOCORTICAL EPILEPSY; SEIZURE FOCI; SURGERY; MRI; PET; SPECT; LOCALIZATION; SUBTRACTION;

D O I：

10.1212/WNL.0b013e318204a380

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objectives: To evaluate the diagnostic value of individual noninvasive presurgical modalities and to study their role in surgical management of nonlesional pediatric epilepsy patients. Methods: We retrospectively studied 14 children (3-18 years) with nonlesional intractable focal epilepsy. Clinical characteristics, surgical outcome, localizing features on 3 presurgical diagnostic tests (subtraction peri-ictal SPECT coregistered to MRI [SISCOM], statistical parametric mapping [SPM] analysis of [F-18] FDG-PET, magnetoencephalography [MEG]), and intracranial EEG (iEEG) were reviewed. The localization of each individual test was determined for lobar location by visual inspection. Concordance of localization between each test and iEEG was scored as follows: 2 = lobar concordance; 1 = hemispheric concordance; 0 = discordance or nonlocalization. Total concordance score in each patient was measured by the summation of concordance scores for all 3 tests. Results: Seven (50%) of 14 patients were seizure-free for at least 12 months after surgery. One (7%) had only rare seizures and 6 (43%) had persistent seizures. MEG (79%, 11/14) and SISCOM (79%, 11/14) showed greater lobar concordance with iEEG than SPM-PET (13%, 3/14) (p < 0.05). SPM-PET provided hemispheric lateralization (71%, 10/14) more often than lobar localization. Total concordance score tended to be greater for seizure-free patients (4.7) than for non-seizure-free patients (3.9). Conclusions: Our data suggest that MEG and SISCOM are better tools for lobar localization than SPM analysis of FDG-PET in children with nonlesional epilepsy. A multimodality approach may improve surgical outcome as well as selection of surgical candidates in patients without MRI abnormalities. Neurology (R) 2011; 76:41-48

引用

页码：41 / 48

页数：8

共 31 条

[1]

Bayley N., 2003, Bayley Scales of Infant and Toddler Development

[2] MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome [J].