Navigated transcranial magnetic stimulation in preoperative evaluation of epilepsy in functional zones
10.3760/cma.j.issn.1671-8925.2017.10.002
- VernacularTitle:结合导航系统的经颅磁刺激在功能区癫痫术前评估中的应用
- Author:
Yujia WEI
1
;
Xianjun SHI
;
Lihong LIU
;
Zhi HOU
;
Jiong YUE
;
Meihua YANG
;
Ning AN
;
Hui YANG
;
Shiyong LIU
Author Information
1. 陆军军医大学第二附属医院神经外科全军癫痫诊治中心
- Keywords:
Transcranial magnetic stimulation;
Eloquent area;
Language area;
Motor area;
Electrical cortical stimulation
- From:
Chinese Journal of Neuromedicine
2017;16(10):978-983
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the value of navigated transcranial magnetic stimulation (nTMS) in preoperative evaluation of epilepsy in functional zones.Methods Retrospective analysis was performed in 12 refractory epilepsy patients had functional cortical lesions and accepted surgery in our hospital from January 2016 to March 2017.The target surgery areas were considered in or near the functional areas by video electroencephalogram and stereotactic electroencephalography or Wada test,nTMS was used to identify the motor or language functional areas before surgery,and direct cortical stimulation (DCS) was performed during the surgery to identify the accuracy of nTMS.Treatment efficacies were evaluated 6-18 months after surgery.Results Hand motor areas were detected in all patients by nTMS,of which 72.7％ patients (8/11,one severe hemispheric atrophy patient was excluded due to functional zone drift to the opposite) were coincided with intraoperative DCS (＜0.5 cm),the deviation distance between 0.5 cm and 1 cm was noted in 27.3％ patients (3/11);motor speech areas were detected in 11 patients with nTMS,72.7％ patients (8/11) were coincided with intraoperative DCS (＜0.5 cm),the deviation distance between 0.5 cm and 1 cm was noted in 27.3％ patients (3/11),18.2％ patients (2/11) were for adjacent relationship,and one was with large difference (＞1.5 cm).And 8 patients had Engel grading Ⅰ outcome (seizure-free),2 had grading Ⅱ outcome (almost seizure-free),and one had grading Ⅲ outcome (worthwhile improvement).No persistent function deficits were noted.Conclusion The nTMS is an accurate,noninvasive and safe functional localization method,which can provide important information for epilepsy patients especially who are not suitable for invasive language evaluation in epilepsy surgery.
