Mirko Avesani1,2, Emanuela Formaggio1,2, F. Milanese1, Anna Baraldo1, Anna Gasparini3, R. Cerini3, Luigi Giuseppe Bongiovanni4, Roberto Pozzi Mucelli3, Antonio Fiaschi1,2, Paolo Manganotti1
1Department of Neurological and Visual Sciences, Section of Rehabilitative Neurology, University of Verona, Italy
2IRCSS, “S. Camillo” Hospital; Venice, Italy
3Department of Morphological and Biomedical Sciences, Section of Radiology, University of Verona, Italy
4Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Italy
Tóm tắt
We used continuous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) to identify the linkage between the “epileptogenic” and the “irritative” area in a patient with symptomatic epilepsy (cavernoma, previously diagnosed and surgically treated), i.e. a patient with a well known “epileptogenic area”, and to increase the possibility of a non invasive pre-surgical evaluation of drug-resistant epilepsies. A compatible MRI system was used (EEG with 29 scalp electrodes and two electrodes for ECG and EMG) and signals were recorded with a 1.5 Tesla MRI scanner. After the recording session and MRI artifact removal, EEG data were analyzed offline and used as paradigms in fMRI study. Activation (EEG sequences with interictal slow-spiked-wave activity) and rest (sequences of normal EEG) conditions were compared to identify the potential resulting focal increase in BOLD signal and to consider if this is spatially linked to the interictal focus used as a paradigm and to the lesion. We noted an increase in the BOLD signal in the left neocortical temporal region, laterally and posteriorly to the poro-encephalic cavity (residual of cavernoma previously removed), that is around the “epileptogenic area”. In our study “epileptogenic” and “irritative” areas were connected with each other. Combined EEG-fMRI may become routine in clinical practice for a better identification of an irritative and lesional focus in patients with symptomatic drug-resistant epilepsy.
