脑磁图在癫痫诊断和治疗中的应用  

Magnetoencephalography in the diagnosis and treatment of epilepsy

作　　者：张宁[1] 李征[2] 乔慧[3] 王拥军[1] 孙波[3] 丁成云[1] 冯毅刚[3] 舒宁[3] 

机构地区：[1]首都医科大学附属北京天坛医院癫痫中心,北京100050 [2]首都医科大学附属北京天坛医院内分泌科,北京100050 [3]北京天坛医院脑磁图中心 北京市神经外科研究所

出　　处：《中国综合临床》2007年第2期109-112,共4页Clinical Medicine of China

基　　金：国家自然科学基金资助项目（30571899）;北京市优秀人才培养专项基金（20042D0300415）

摘　　要：目的应用脑磁图（MEG）技术对致痫灶进行定位，比较其与头皮脑电图（EEG）在神经影像学方法的应用价值，探讨MEG技术对癫痫灶定位的应用前景。方法对113例癫痫患者进行手术治疗，术前均通过临床症候学、头皮EEG、MRI、MEG检查，进行MEG与其他检查方法和临床症候学在定侧、定叶诊断的对比研究。手术在皮层EEG及脑深部EEG监测下进行，手术治疗结果以Engel疗效分级评价。所有手术标本常规行光镜检查。结果113例患者中MEG定位局限于单个叶的为91例，头皮EEG仅为30例。术前致痫灶定位依据多种检查结果和临床症候学综合定位。MEG与MRI、临床症候学在定侧诊断准确性方面比较差异有显著性。MEG与MRI在定叶诊断准确性方面的比较差异有显著性。36例术前头皮EEG表现为双侧或全导癫痫波的癫痫患者，其中有34例MEG表现为单侧癫痫波，具有定侧诊断的意义。结论头皮EEG、MRI、正电子发射计算机断层扫描（PET）、临床症候学均不足以做出独立精确的致痫灶定位诊断，综合比较MEG比上述方法定侧和定叶的准确性高。MEG空间分辨率、时间分辨率高，有助于区分致痫灶和镜灶。Objective To explore the clinical application value and feasibility of magnetoencephalography （MEG） in the localization of epileptogenic zone and to compare with scalp electroencephalography and other neuroimaging techniques. Methods 113 patients were valued by clinical semiology, MEG, scalp EEG, and MRI before surgery. In operation the patients underwent ECoG and deep EEG monitor. The surgical effects were evaluated by Engle curative effect grading. Results There were 91 patients whose epileptopgenic zone was limited to one lobe by MEG among 113 patients; while 30 by scalp EEG. There was significant difference between MEG and EEG/MRI/semiology. There was significant difference between MEG and MRI in localization of lobe. 34 epilepsy cases of 36 with bilateral or full-wire epilepsy wave manifested unilateral epilepsy wave, with significant diagnostic value. Conclusion It is impossible to localize the epileptogenic zone accurately only by any one of clinical semiology, PET, scalp EEG, or MRI. MEG is better in localization, with a higher time and space resolution, and may help to identify epileptogenic zone and mirror foci.

关 键 词：癫痫 脑磁图 

分 类 号：R44[医药卫生—诊断学] R742[医药卫生—临床医学]