Drug-resistant focal epilepsy is a major clinical problem and surgery is under-used. Better non-invasive techniquesfor epileptogenic zone (EZ) localisation are needed when MRI shows no lesion or an extensive lesion. The problem is interictal (IED) and ictal localisation before propagation from the EZ. High-density electroencephalography (HDEEG) and magnetoencephalography (MEG) offer millisecond-order temporal resolution to address this but co-acquisition is challenging, ictal MEG studies are rare, long-term prospective studies are lacking, and fundamental questions remain. Should HDEEG-MEG discharges be assessed independently (ESL, MSL) or combined (EMSL) for source localisation? Which phase of the discharge best characterises the EZ (defined by intracranial EEG (ICEEG) and surgical resection (SU) relative to outcome)? Does this differ for interictal and ictal discharges? Does MEG detect mesial temporal lobe discharges? We present our prospective findings on a large cohort of Australian patients with long-term pre- and post-operative follow-up. The results shed new light on these questions and challenge current practice with its reliance on invasive monitoring in these patients.
Drug-resistant focal epilepsy is a major clinical problem and surgery is still under-used despite advances in both invasive and non-invasive modalities and technologies. The correct identification of the epileptogenic zone remains central to successful treatment of seizures, however this currently can only be verified empirically after resection.The number of structural and functional biomarkers offered in predicting this epileptogenic zone are broad and a reductionist approach suggesting a “single” critical factor or modality for its prediction will vary both across and within syndromes. A clear working knowledge of each modality, it’s analysis and limits therefore becomes super-additive in establishing information and insights when safely optimising the individual seizure control and improving their quality of life. In our cohort of Australian refractory focal epilepsy patients, we practically outline our temporo-spatial philosophy to tailoring pre-surgical investigations from a series of cases to illustrate our multimodal approaches toward successful surgical treatment.
May 31, 2019
For more details, please refer to 基于多模态分析的癫痫病灶定位及手术规划