Magnetoencephalography in Patients with Tuberous Sclerosis and Localization-related Epilepsy

Authors: Kamimura, Takanori; Tohyama, Jun¹; Oishi, Makoto²; Akasaka, Noriyuki¹; Kanazawa, Osamu¹; Sasagawa, Mutsuo³; Kato, Mitsuhiro⁴; Ohno, Kousaku⁵; Masuda, Hiroshi²; Kameyama, Shigeki²; Uchiyama, Makoto⁶

Source: Epilepsia, Volume 47, Number 6, June 2006 , pp. 991-997(7)

Publisher: Blackwell Publishing

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Abstract:

Summary:

Purpose: To clarify the usefulness of magnetoencephalography (MEG) for diagnosis of the spatial relations between spike foci and suspicious epileptogenic tubers on MRI in patients with tuberous sclerosis (TS) and to compare MEG spike foci with single-photon emission computed tomography (SPECT) findings.

Methods: We analyzed magnetic fields of epileptic spike discharges in 15 patients with TS and localization-related epilepsy (LRE) by using MEG (a whole-head 204-channel magnetometer system). We investigated the spatial relation between the equivalent current dipoles (ECDs) of interictal spike discharges and visible cortical tubers on MRI. We also compared results of MEG and MRI with SPECT findings.

Results: MEG detected a cluster of ECDs around one cortical tuber in six of 15 patients and clusters of ECDs around two cortical tubers in five patients. Interictal SPECT was disappointing in detection of epileptic foci in TS. However, MEG spike foci showed spatial consistency with ictal hyperperfusion areas in two patients. Three patients with single ECD clusters underwent surgical treatment: two have been seizure free, and one has obtained seizure reduction of >90%.

Conclusions: ECDs were located around visible tuber nodules. MEG enabled precise localization of the epileptic foci and provided crucial information for surgical treatment in patients with TS and partial epilepsy. TS patients showing a single ECD cluster on MEG may be appropriate candidates for surgical treatment.

Keywords: Tuberous sclerosis; Symptomatic localization-related epilepsy; Magnetoencephalography; SPECT; Epileptic focus

Document Type: Research article

DOI: 10.1111/j.1528-1167.2006.00511.x

Affiliations: 1: Pediatric Neurology 2: Neurosurgery 3: Psychiatry, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata 4: Department of Pediatrics, Yamagata University School of Medicine, Yamagata 5: Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan 6: Division of Pediatrics, Department of Homeostatic Regulation and Development, Course for Biological Functions and Medical Control, Niigata Graduate School of Medical and Dental Sciences

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