该研究得到了北京大学第一医院 IRB 的批准，并获得了所有参与者的书面知情同意书。
注：纳入 2017 年 1 月 1 日至 2022 年 3 月 1 日在北京大学第一医院儿科癫痫中心接受额叶断线术的所有顽固性癫痫患儿并进行分析。纳入符合 MOGHE 临床和放射学标准且 MRI 提示致癫痫病灶局限于额叶的患者。MOGHE 的组织病理学诊断标准之前已经描述过6.进行精学、发作期和发作间期脑电图 （EEG） 、磁共振成像 （MRI） 、发作间期 18氟脱氧葡萄糖正电子发射断层扫描 （PET） 和发育评估进行术前评估。7 岁以上的儿童通过 Wechsler Intelligence Scale-IV 进行评估，7 岁以下的儿童通过 Griffith Developmental Assessment Scale 进行评估。通过 ILAE 分类评估癫痫的结局，ILAE 1 的患者被认为无癫痫发作8。符号学分为 3 组 （局灶性、痉挛/全身性癫痫发作和混合型）。发作间期脑电图分为局灶性 （区域放电） 、多灶性 （几个单侧半球区域放电） 和弥漫性 （对侧受累）。发作期脑电图分为局灶性（区域性发作）、弥漫性（单侧半球发作或非定位性脑电图）和局灶性/弥漫性（2 种模式共存）9。根据 Hartlieb 等人 7 对 MOGHE 的分型，8 例患者的 MRI 结果也被分为 1 型（图 1A、B）或 2 型。 图 1 显示了患者 8 额部断开的代表性术中照片和术前和术后图像。
1. 定位
<ol><li>使用标准技术对患者进行全身麻醉。</li>
	<li>根据解剖标志定位外侧裂、冠状缝和中央沟，作为绘制手术切口线的参考。在中线外 1.0 厘米处和冠状缝合线前 2-3 厘米处做一个“7”形的皮肤切口。确保切口的后缘包括中央前回并向下延伸到翼状区域（图 1D）</li>
	<li>将患者仰卧，头部转向对侧。在肩膀下方放置一个肩垫以帮助头部转动。</li>
	<li>通过无菌准备皮肤和覆盖手术区域，在整个手术过程中保持无菌条件。</li>
</ol>2. 开仓
<ol><li>切开头皮和肌肉。小心将肌肉分层切割。</li>
	<li>用手术刀将头皮和骨膜分开。 注意：保留骨膜可减少术后皮下水肿。</li>
	<li>使用直径为 1 cm 的高速钻头钻三个 1 cm 的孔，然后用 1 mm 宽的铣刀铣削骨瓣。 注意：需要充分暴露蝶骨嵴，以促进额基的后续断开。</li>
	<li>使用骨蜡、明胶海绵和双极烧灼术实现止血。</li>
	<li>在骨缘钻 4-5 个 1 毫米的孔并悬吊硬脑膜以避免硬膜外血肿。</li>
	<li>在距离骨缘 0.5 cm 的地方切开硬脑膜。暴露中央前回、额下回的后部和外侧裂的起点。（图 1E）</li>
</ol>3. 额部断开程序
<ol><li>在手术前使用立体定向系统软件进行手术计划。将 3D T1、天赋加权图像和 PET 数据导入软件中，用于配准和 3D 重建10。 注意：中央前沟通过 3D 共配准描绘。未进行中央回的术中标测（图 1C）。</li>
	<li>选择术前影像学检查异常最严重的区域进行组织学检查。</li>
	<li>切除额下回的后部，以完全暴露岛叶的 1 和 2 短回。 注意：在疑似额部 MOGHE 的 5 岁以下儿童中，不考虑保留语音区域，以最大限度地扩大致癫痫区的断开程度。</li>
	<li>断开额叶基部和沿前岛叶到蝶骨嵴的纤维，然后到中线。 注意：大脑前动脉和嗅三角是断开后边界的标志。直回位于嗅神经内侧，额叶基底的断开需要到达中线软脑膜。对侧脑组织必须保存完好。</li>
	<li>沿着中央前沟解剖灰质和白质。中线断开的边界是脑镰，向下到扣带回，相应地断开它。<ol><li>当沿中央前沟进行额内断开时，稍微向前断开沟底部下方的白质，以使锥体束完整。</li>
		<li>另一方面，由于 MOGHE 是灰白质边界模糊的白质病变，因此请进行足够深的切除/断开，以实现最高的无癫痫发作机会。</li>
	</ol></li>
	<li>切开胼胝体，打开同侧脑室，沿脑室顶部至前角完全解剖弓状纤维，然后与额基断开线相遇。 注意：到目前为止，整个前侧脑室是完全开放的。</li>
	<li>将前胼胝体与侧脑室内的前连合断开，其中额基底骨断开的后部达到胼胝体断开的水平。</li>
	<li>暴露大脑前动脉，这可能是胼胝体断开的解剖标志。最后，用抽吸术切除大脑前动脉后面的末端旁回和后回直肌。 注意：额基底骨断开应完全断开，包括末端旁回和后回直肌;否则，癫痫发作的结果将受到很大影响。额叶断开通常伴有根据术前评估切除 1 或/和 2 个岛叶短回，从而有助于更全面地切除致癫痫区。断开连接后的照片和术后 MRI 如图 1 所示。应积极考虑切除 1 和 2 个短岛叶回，尤其是术前 MRI 和 PET 提示异常时。</li>
</ol>4. 关闭
<ol><li>用 4-0 可吸收缝合线缝合硬脑膜，以实现紧密闭合。</li>
	<li>放置硬膜外引流管 2 天。</li>
	<li>使用 3 个可吸收的颅骨锁固定骨骼。</li>
	<li>用 4-0 根皮下缝合线闭合皮下层。</li>
	<li>用吻合器缝合皮肤。</li>
</ol>

MOGHE 和癫痫：额叶断开手术的结果 

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Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+characteristics+and+surgical+outcomes+in+children+with+mild+malformation+of+cortical+development+and+oligodendroglial+hyperplasia+in+epilepsy.">Clinical characteristics and surgical outcomes in children with mild malformation of cortical development and oligodendroglial hyperplasia in epilepsy.</a> Epilepsia Open. 8 (3), 898-911 (2023).</li><li>Hartlieb, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age-related+MR+characteristics+in+mild+malformation+of+cortical+development+with+oligodendroglial+hyperplasia+and+epilepsy+(MOGHE).">Age-related MR characteristics in mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE).</a> Epilepsy Behav. 91, 68-74 (2019).</li><li>Wieser, H. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proposal+for+a+new+classification+of+outcome+with+respect+to+epileptic+seizures+following+epilepsy+surgery.">Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery.</a> Epilepsia. 42 (2), 282-286 (2001).</li><li>Wang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Disconnection+surgery+in+pediatric+epilepsy:+A+single+center's+experience+with+185+cases.">Disconnection surgery in pediatric epilepsy: A single center's experience with 185 cases.</a> Neurosurgery. 93 (6), 1251-1258 (2023).</li><li>Wang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Seizure+and+cognitive+outcomes+of+posterior+quadrantic+disconnection:+A+series+of+12+pediatric+patients.">Seizure and cognitive outcomes of posterior quadrantic disconnection: A series of 12 pediatric patients.</a> Br J Neurosurg. 34 (6), 677-682 (2020).</li><li>Gaballa, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+characteristics+and+postoperative+seizure+outcome+in+patients+with+mild+malformation+of+cortical+development+and+oligodendroglial+hyperplasia.">Clinical characteristics and postoperative seizure outcome in patients with mild malformation of cortical development and oligodendroglial hyperplasia.</a> Epilepsia. 62 (12), 2920-2931 (2021).</li><li>Barba, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+features,+neuropathology,+and+surgical+outcome+in+patients+with+refractory+epilepsy+and+brain+somatic+variants+in+the+slc35a2+gene.">Clinical features, neuropathology, and surgical outcome in patients with refractory epilepsy and brain somatic variants in the slc35a2 gene.</a> Neurology. 100 (5), e528-e542 (2023).</li><li>Garganis, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frontal+lobe+epilepsy+and+mild+malformation+with+oligodendroglial+hyperplasia:+Further+observations+on+electroclinical+and+imaging+phenotypes,+and+surgical+perspectives.">Frontal lobe epilepsy and mild malformation with oligodendroglial hyperplasia: Further observations on electroclinical and imaging phenotypes, and surgical perspectives.</a> Epileptic Disord. 25 (3), 343-359 (2023).</li><li>Willard, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Seizure+outcome+after+surgery+for+mri-diagnosed+focal+cortical+dysplasia:+A+systematic+review+and+meta-analysis.">Seizure outcome after surgery for mri-diagnosed focal cortical dysplasia: A systematic review and meta-analysis.</a> Neurology. 98 (3), e236-e248 (2022).</li><li>Kalbhenn, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operative+posterior+disconnection+in+epilepsy+surgery:+Experience+with+29+patients.">Operative posterior disconnection in epilepsy surgery: Experience with 29 patients.</a> Epilepsia. 60 (9), 1973-1983 (2019).</li><li>Devlin, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+of+hemispherectomy+for+epilepsy+in+childhood+and+adolescence.">Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence.</a> Brain. 126 (Pt 3), 556-566 (2003).</li><li>Marras, C. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemispherotomy+and+functional+hemispherectomy:+Indications+and+outcome.">Hemispherotomy and functional hemispherectomy: Indications and outcome.</a> Epilepsy Res. 89 (1), 104-112 (2010).</li><li>Castagno, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Seizure+outcomes+of+large+volume+temporo-parieto-occipital+and+frontal+surgery+in+children+with+drug-resistant+epilepsy.">Seizure outcomes of large volume temporo-parieto-occipital and frontal surgery in children with drug-resistant epilepsy.</a> Epilepsy Res. 177, 106769 (2021).</li><li>Kamalboor, H., Alhindi, H., Alotaibi, F., Althubaiti, I., Alkhateeb, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frontal+disconnection+surgery+for+drug-resistant+epilepsy:+Outcome+in+a+series+of+16+patients.">Frontal disconnection surgery for drug-resistant epilepsy: Outcome in a series of 16 patients.</a> Epilepsia Open. 5 (3), 475-486 (2020).</li></ol>

作者没有什么可披露的。

MOGHE 是一种主要位于 GM/WM 边界的新白质实体，但没有像 FCD2 那样表现出皮质层杂乱无章。非典型的符号学和广泛的脑电图使得使用传统的解剖电临床评估方法很难确定致癫痫区的位置，这给手术决策带来了困难。以前的研究报告称，MOGHE 患者在广泛切除后取得了良好的结果 6,11，但缺乏详细信息。然而，有文献报道，广泛额叶切除术?...

皮质发育畸形 （MCD） 是幼儿耐药性癫痫和发育迟缓的重要原因。MCD 的类型很多，其中 FCD 是最常见的1 型。根据 2022 年最新更新的 FCD 分类，MOGHE 被描述和分类为以白质为主的病变，相比之下，近皮质局限性 FCD2 主要被描述为增殖性少突胶质细胞增生伴癫痫 （POGHE）3，并于 2017 年首次提出4。MOGHE 的定义是标本 2,4,5 中白质和深皮层中异位神经元的增加超过 2200 个 Olig2 免疫反应细胞/mm2。
临床上，MOGHE 最常见于额叶，癫痫发作痉挛是最常见的初始癫痫发作类型6。发作间期脑电图模式通常是多灶性的或在幼儿中广泛存在6。在年幼的儿童中，MRI 显示灰白质交界处的层状信号增加。在年龄较大的儿童中，观察到皮层下 T2/FLAIR 信号减少和灰白质转变模糊7。在临床实践中，准确描述 MOGHE 非常困难。因此，传统的术前评估通过综合解剖-电-临床评估来确定致癫痫区范围的概念和策略难以实施。在此，分析了额叶中 MOGHE 的儿科队列，以扩展 MOGHE 手术治疗知识。

<table><tbody><tr><td>Absorbable cranial bone lock</td><td>Braun Inc.</td><td>FF016</td><td></td></tr><tr><td>Drainage</td><td>Branden Inc.</td><td>Fr12</td><td></td></tr><tr><td>High-speed drill</td><td>Stryker</td><td>5400-050-000</td><td></td></tr><tr><td>Microscope</td><td>Leica Inc.</td><td>M525F40</td><td></td></tr><tr><td>NIHON KOHDAN EEG system</td><td>NIHON KOHDAN Inc.</td><td>EEG-1200C</td><td>EEG&amp;nbsp;</td></tr><tr><td>Philips PET-CT system</td><td>Philips Inc.</td><td>Gemini GXL</td><td>PET-CT</td></tr><tr><td>Sinovation Stereotactic system</td><td>Sinovation Inc.</td><td>SR1</td><td>3D construction</td></tr></tbody></table>

frontal disconnection for treating mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (moghe) in the frontal lobe

皮质发育畸形是幼儿耐药性癫痫的重要原因。癫痫中少突胶质细胞增生的轻度皮质发育畸形 （MOGHE） 已被添加到最后一个局灶性皮质发育不良 （FCD） 分类中，通常累及额叶。癫痫发作时的符号学以非偏侧性婴儿痉挛症为主;畸形的边界通常难以通过磁共振成像 （MRI） 和正电子发射断层扫描 （PET） 确定，并且脑电图 （EEG） 结果通常很普遍。因此，传统的术前评估通过综合解剖-电-临床方法确定致癫痫区范围的理念和策略难以实施。 
额叶断开术是治疗癫痫的一种有效的手术方法，但相关报道较少。回顾性研究了 8 例经组织病理证实的 MOGHE 患儿。MOGHE 位于所有患者的额叶，并进行额叶断开。在断开连接手术中使用岛周入路，分为几个手术步骤：额下回部分切除术、额基底和额内断开以及前体胼胝切开术。 
1 例患者表现为短期术后言语障碍，而 1 例患者表现出短暂的术后肢体无力。未观察到长期术后并发症。术后 2 年，75% 的患者无癫痫发作，其中一半患者认知能力得到改善。这一发现表明，额叶断开术是治疗 MOGHE 的一种有效且安全的外科手术，而不是额叶的广泛切除。

根据纳入标准，共有 8 名符合条件的患者被纳入分析。该小组由 8 名男孩组成。发病年龄为 4-28 个月 （中位 6 个月），手术年龄为 17-135 个月 （中位 38 个月）。癫痫持续时间为 13 至 121 个月 （中位数为 32 个月）。4 例患者的符号为癫痫性痉挛，3 例为局灶性癫痫发作，1 例为混合性癫痫发作。发作间期 EEG 显示 3 例局灶性，3 例患者多灶性，2 例患者弥漫性。发作期脑电图显示 5 例患者为局灶性，...

作者聚焦：研究 MOGHE 患者额叶断开后的临床特征和癫痫结果

在这里，我们提出了一个方案来描述 8 例额叶断开后额叶少突胶质细胞增生 （MOGHE） 轻度皮质发育畸形患者的癫痫结果和并发症。该程序的特点是简单、用户友好和术后并发症较少。

额叶断开治疗额叶少突胶质细胞增生症 （MOGHE） 皮质发育轻度畸形

Malformation of cortical development is an important cause of drug-resistant epilepsy in young children. Mild malformation of cortical development with ...

frontal-disconnection-for-treating-mild-malformation-cortical

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Frontal Disconnection for Treating Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Epilepsy (MOGHE) in the Frontal Lobe

671 次观看.  Peking University First Hospital. 我们研究了 MOGHE 的术后癫痫结局。由于 MOGHE 的临床特点，传统的理念和术前评估确定致癫痫区程度的策略难以实施。我们尝试分析位于额叶的 MOGHE 额叶断开后的癫痫结果和并发症。对于 MOGHE 患者，切除范围应相对较大。MRI 可分为两种类型。1 型皮髓交界处层状 T2 和 FLAIR 信号增加，2 型由于相邻白质信号增加，皮髓分化减少。额叶断开是...

视频: 作者聚焦：研究 MOGHE 患者额叶断开后的临床特征和癫痫结果

Network Analysis of the Default Mode Network Using Functional Connectivity MRI in Temporal Lobe Epilepsy

Functional connectivity MRI (fcMRI) is an fMRI method that examines the connectivity of different brain areas based on the correlation of BOLD signal fluctuations over time. Temporal Lobe Epilepsy (TLE) is the most common type of adult epilepsy and involves multiple brain networks. The default mode network (DMN) is involved in conscious, resting state cognition and is thought to be affected in TLE where seizures cause impairment of consciousness. The DMN in epilepsy was examined using seed based fcMRI. The anterior and posterior hubs of the DMN were used as seeds in this analysis. The results show a disconnection between the anterior and posterior hubs of the DMN in TLE during the basal state. In addition, increased DMN connectivity to other brain regions in left TLE along with decreased connectivity in right TLE is revealed. The analysis demonstrates how seed-based fcMRI can be used to probe cerebral networks in brain disorders such as TLE.

The Default Mode Network (DMN) in Temporal Lobe Epilepsy (TLE) is analyzed in the resting state of the brain using seed-based functional connectivity MRI (fcMRI).

使用功能性磁共振成像连接在颞叶癫痫默认模式网络的网络分析

Functional connectivity MRI (fcMRI) is an fMRI method that examines the connectivity of different brain areas based on the correlation of BOLD signal ...

科研

医学

Investigating the Function of Deep Cortical and Subcortical Structures Using Stereotactic Electroencephalography: Lessons from the Anterior Cingulate Cortex

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure involves the chronic placement of multiple depth electrodes into regions of the brain typically inaccessible via subdural grid electrode placement. SEEG thus provides a unique opportunity to investigate brain function. In this paper we demonstrate how SEEG can be used to investigate the role of the dorsal anterior cingulate cortex (dACC) in cognitive control. We include a description of the SEEG procedure, demonstrating the surgical placement of the electrodes. We describe the components and process required to record local field potential (LFP) data from consenting subjects while they are engaged in a behavioral task. In the example provided, subjects play a cognitive interference task, and we demonstrate how signals are recorded and analyzed from electrodes in the dorsal anterior cingulate cortex, an area intimately involved in decision-making. We conclude with further suggestions of ways in which this method can be used for investigating human cognitive processes.

Stereotactic Electroencephalography (SEEG) is an operative technique used in epilepsy surgery to help localize seizure foci. It also affords a unique opportunity to investigate brain function. Here we describe how SEEG can be used to investigate cognitive processes in human subjects.

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure ...

神经科学

Direct-current Stimulation and Multi-electrode Array Recording of Seizure-like Activity in Mice Brain Slice Preparation

Cathodal transcranial direct-current stimulation (tDCS) induces suppressive effects on drug-resistant seizures. To perform effective actions, the stimulation parameters (e.g., orientation, field strength, and stimulation duration) need to be examined in mice brain slice preparations. Testing and arranging the orientation of the electrode relative to the position of the mice brain slice are feasible. The present method preserves the thalamocingulate pathway to evaluate the effect of DCS on anterior cingulate cortex seizure-like activities. The results of the multichannel array recordings indicated that cathodal DCS significantly decreased the amplitude of the stimulation-evoked responses and duration of 4-aminopyridine and bicuculline-induced seizure-like activity. This study also found that cathodal DCS applications at 15 min caused long-term depression in the thalamocingulate pathway. The present study investigates the effects of DCS on thalamocingulate synaptic plasticity and acute seizure-like activities. The current procedure can test the optimal stimulation parameters including orientation, field strength, and stimulation duration in an in vitro mouse model. Also, the method can evaluate the effects of DCS on cortical seizure-like activities at both the cellular and network levels.

Studies have shown that cathodal transcranial direct-current stimulation can produce suppressive effects on drug-resistant seizures. In this study, an in vitro experimental setup was devised in which the direct-current stimulation and multielectrode array recording of seizure-like activity were evaluated in mice brain slice preparation. The direct-current stimulation parameters were evaluated.

小鼠脑切片准备扣押样活性的直接电流刺激和多电极阵列记录

Cathodal transcranial direct-current stimulation (tDCS) induces suppressive effects on drug-resistant seizures. To perform effective actions, the ...

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.

Surgery is the gold standard for accessible arteriovenious malformations (AVMs), and pre-operative embolization can simplify this procedure. We describe our approach for staged endovascular embolization and open resection of AVMs, and provide a representative clinical example highlighting the advantages of a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team.

脑动静脉畸形的综合血管内和开放性手术治疗

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency Oscillations (HFOs) have emerged as potential presurgical biomarkers for the identification of the EZ in addition to Interictal Epileptiform Discharges (IEDs) and ictal activity. Although they are promising to localize the EZ, they are not yet suited for the diagnosis or monitoring of epilepsy in clinical practice. Primary barriers remain: the lack of a formal and global definition for HFOs; the consequent heterogeneity of methodological approaches used for their study; and the practical difficulties to detect and localize them noninvasively from scalp recordings. Here, we present a methodology for the recording, detection, and localization of interictal HFOs from pediatric patients with refractory epilepsy. We report representative data of HFOs detected noninvasively from interictal scalp EEG and MEG from two children undergoing surgery.
The underlying generators of HFOs were localized by solving the inverse problem and their localization was compared to the Seizure Onset Zone (SOZ) as this was defined by the epileptologists. For both patients, Interictal Epileptogenic Discharges (IEDs) and HFOs were localized with source imaging at concordant locations. For one patient, intracranial EEG (iEEG) data were also available. For this patient, we found that the HFOs localization was concordant between noninvasive and invasive methods. The comparison of iEEG with the results from scalp recordings served to validate these findings. To our best knowledge, this is the first study that presents the source localization of scalp HFOs from simultaneous EEG and MEG recordings comparing the results with invasive recordings. These findings suggest that HFOs can be reliably detected and localized noninvasively with scalp EEG and MEG. We conclude that the noninvasive localization of interictal HFOs could significantly improve the presurgical evaluation for pediatric patients with epilepsy.

High Frequency Oscillations (HFOs) have emerged as presurgical biomarkers for the identification of the epileptogenic zone in pediatric patients with medically refractory epilepsy. A methodology for the noninvasive recording, detection, and localization of HFOs with simultaneous scalp electroencephalography (EEG) and magnetoencephalography (MEG) is presented.

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency ...

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ET can have a significant impact on quality of life, mood, functional activities, and socialization. Patients suffering from ET not sufficiently treated with first line medications may be eligible for alternative strategies such as deep brain stimulation, radiofrequency ablation, and MRI guided focused ultrasound (MRgFUS). High-intensity MRgFUS is an emerging modality to treat ET, its attraction for patients being that it is noninvasive and associated with short recovery time, as patients are home the day after treatment. While MRgFUS centers are still limited, it will become important for clinicians to consider MRgFUS as a treatment alternative, particularly in the case of a patient for whom open surgery is contraindicated. This article outlines the steps of patient selection, equipment setup, sonication, and post-treatment follow-up, as well as critical steps to be aware of when performing a MRgFUS procedure.

High-intensity MRI guided focused ultrasound is an emerging noninvasive technique to precisely ablate brain tissue. It has been shown to be safe and effective in treating medically-refractory essential tremor. This article describes the protocol for thalamotomy from patient selection to equipment setup to post-treatment follow-up.

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

<meta charset="utf8"></head><body>将 MEG 和 HD-EEG 整合到儿科癫痫定位中

Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic zone (EZ) while preserving the eloquent brain areas. The development of a reliable and noninvasive localization method that provides clinically useful information for the localization of the EZ is, therefore, crucial to achieving successful surgical outcomes. Electric and magnetic source imaging (ESI and MSI) have been increasingly utilized in the presurgical evaluation of these patients showing promising findings in the delineation of epileptogenic as well as eloquent brain areas. Moreover, the combination of ESI and MSI into a single solution, namely electromagnetic source imaging (EMSI), performed on simultaneous high-density electroencephalography (HD-EEG) and magnetoencephalography (MEG) recordings has shown higher source localization accuracy than either modality alone. Despite these encouraging findings, such techniques are performed in only a few tertiary epilepsy centers, are rarely recorded simultaneously, and are underutilized in pediatric cohorts. This study illustrates the experimental setup for recording simultaneous MEG and HD-EEG data as well as the methodological framework for analyzing these data aiming to localize the irritative zone, the seizure onset zone, and eloquent brain areas in children with DRE. More specifically, the experimental setups are presented for (i) recording and localizing interictal and ictal epileptiform activity during sleep and (ii) recording visual-, motor-, auditory-, and somatosensory-evoked responses and mapping relevant eloquent brain areas (i.e., visual, motor, auditory, and somatosensory) during visuomotor task, as well as auditory and somatosensory stimulations. Detailed steps of the data analysis pipeline are further presented for performing EMSI as well as individual ESI and MSI using equivalent current dipole (ECD) and dynamic statistical parametric mapping (dSPM).

<meta charset="utf8"></head><body>作者聚焦:通过新型生物标志物和增强定位推进儿童癫痫手术

Magnetoencephalography (MEG) and high-density electroencephalography (HD-EEG) are rarely recorded simultaneously, although they yield confirmatory and complementary information. Here, we illustrate the experimental setup for recording simultaneous MEG and HD-EEG and the methodology for analyzing these data aiming to localize epileptogenic and eloquent brain areas in children with drug-resistant epilepsy.

电磁源显像在儿童耐药性癫痫术前评估中的应用

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic ...

额叶断开治疗额叶少突胶质细胞增生症（MOGHE）皮质发育轻度畸形

副本

摘要

探索更多视频

此视频中的章节

使用功能性磁共振成像连接在颞叶癫痫默认模式网络的网络分析

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

小鼠脑切片准备扣押样活性的直接电流刺激和多电极阵列记录

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

脑动静脉畸形的综合血管内和开放性手术治疗

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

电磁源显像在儿童耐药性癫痫术前评估中的应用

电磁源显像在儿童耐药性癫痫术前评估中的应用

额叶断开治疗额叶少突胶质细胞增生症 （MOGHE） 皮质发育轻度畸形

副本

摘要

探索更多视频

此视频中的章节

使用功能性磁共振成像连接在颞叶癫痫默认模式网络的网络分析

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

小鼠脑切片准备扣押样活性的直接电流刺激和多电极阵列记录

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

脑动静脉畸形的综合血管内和开放性手术治疗

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

电磁源显像在儿童耐药性癫痫术前评估中的应用

电磁源显像在儿童耐药性癫痫术前评估中的应用

额叶断开治疗额叶少突胶质细胞增生症（MOGHE）皮质发育轻度畸形

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训