臨床検査53巻9号

2009年09月発行

今月の主題 脳磁図で何がわかるか？ 各論

小児てんかんの磁場源解析

著者： 藤原久子¹ 大坪宏²

所属機関： ¹シンシナティ小児病院神経科 ²トロント小児病院神経科臨床神経生理部門

ページ範囲：P.1057 - P.1064

　小児神経科領域のなかで小児てんかんの占める割合は大きい．脳磁図(MEG)は，てんかん棘波の電流源の双極子推定を行うことで，小児てんかんの診断・治療において重要な役割を占めるようになってきている．小児に特異的なてんかんとてんかん症候群では，てんかん棘波の局在部位と性質をMEGで評価できる．小児難治性てんかんの多くが側頭葉外てんかんであり，神経移動障害の病理所見を示すが，このような症例においても，MEGはてんかん焦点を正確に同定でき，難治性てんかんに対する外科的治療におおいに役立っている．小児の発達・学習障害などにもMEGによる脳機能障害の解明を行う研究がなされている．本稿では，小児に特異的な良性てんかんの診断，難治性てんかんの外科的治療の術前検査，発達・学習障害へのMEGの応用について述べる．

参考文献

1) Lombroso CT：Sylvian seizures and midtemporal spike foci in children. Arch Neurol　17：52-59, 1967

2) Minami T, Gondo K, Yamamoto T, et al：Magnetoencephalographic analysis of rolandic discharges in benign childhood epilepsy. Ann Neurol　39：326-334, 1996

3) Ishitobi M, Nakasato N, Yamamoto K, et al：Opercular to interhemispheric source distributionof benign rolandic spikes of childhood. Neuroimage　25：417-423, 2005

4) Landau WM, Kleffner FR：Syndrome of acquired aphasia with convulsive disorder in childhood. Neurology　7：523-530, 1957

5) Patry G, Lyagoubi S, Tassinari CA：Subclinical "electrical status epilepticus" induced by sleep in children. A clinical and electroencephalographic study of six cases. Arch Neurol　24：242-252, 1971

6) Tassinari CA, Dravet C, Roger J：Encephalopathy related to electrical status epilepticus during slow sleep. Elect Clin Neurophysiol　43：529-530, 1977

7) Morrell F, Whisler WW, Bleck TP：Multiple subpial transection：a new approach to the surgical treatment of focal epilepsy. J Neurosurg　70：231-239, 1989

8) Paetau R, Granstrom ML, Blomstedt G, et al：Magneto encephalography in presurgical evaluation of children with the Landau-Kleffner syndrome. Epilepsia　40：326-335, 1999

9) Sobel DF, Aung M, Otsubo H, et al：Magnetoencephalography in children with Landau-Kleffner syndrome and acquired epileptic aphasia. AJNR Am J Neuroradiol　21：301-307, 2000

10) Panayiotopoulos CP：Inhibitory effect of central vision on occipital lobe seizures. Neurology　31：1330-1333, 1981

11) Panayiotopoulos CP：Panayiotopoulos Syndrome：A common and benign childhood epileptic syndrome. John Libbey and Company, London, 2002

12) Martinovic Z：Panayiotopoulos syndrome or early-onset benign childhood occipital epilepsy. Epilepsia　43：1270-1271, 2002

13) Ohtsu M, Oguni H, Hayashi K, et al：EEG in children with early-onset benign occipital seizure susceptibility syndrome：Panayiotopoulos syndrome. Epilepsia　44：435-442, 2003

14) Kanazawa O, Tohyama J, Akasaka N, et al：A magnetoencephalographic study of patients with Panayiotopoulos syndrome. Epilepsia　46：1106-1113, 2005

15) Chugani HT, Shields WD, Shewmon DA, et al：Infantile spasms：I. PET identifies focal cortical dysgenesis in cryptogenic cases for surgical treatment. Ann Neurol　27：406-413, 1990

16) Otsubo H, Chitoku S, Ochi A, et al：Malignant rolandic-sylvian epilepsy in children：diagnosis, treatment, and outcomes. Neurology　57：590-596, 2001

17) Mohamed A, Wyllie E, Ruggieri P, et al：Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery. Neurology　56：1643-1649, 2001

18) Iida K, Otsubo H, Mohamed IS, et al：Characterizing magnetoencephalographic spike sources in children with tuberous sclerosis complex. Epilepsia　46：1510-1517, 2005

19) Wu JY, Sutherling WW, Koh S, et al：Magnetic source imaging localizes epileptogenic zone in children with tuberous sclerosis complex. Neurology　66：1270-1272, 2006

20) Weiner HL, Ferraris N, LaJoie J, et al：Epilepsry surgery for children with tuberous sclerosis complex. J Child Neurol　19：687-689, 2004

21) Edwards JC, Wyllie E, Ruggeri PM, et al：Seizure outcome after surgery for epilepsy due to malformation of cortical development. Neurology　55：1110-1114, 2000

22) Gupta A, Raja S, Kotagal P：Ictal SPECT in children with partial epilepsy due to focal cortical dysplasia. Pediatr Neurol　31：89-95, 2004

23) Otsubo H, Iida K, Oishi M, et al：Neurophysiologic findings of neuronal migration disorders：intrinsic epileptogenicity of focal cortical dysplasia on electroencephalography, electrocorticography, and magnetoencephalography. J Child Neurol　20：357-363, 2005

24) Widjaja E, Otsubo H, Raybaud C, et al：Characteristics of MEG and MRI between Taylor's focal cortical dysplasia(typeⅡ)and other cortical dysplasia：surgical outcome after complete resection of MEG spike source and MR lesion in pediatric cortical dysplasia. Epilepsy Res　82：147-155, 2008

25) Widjaja E, Zarei Mahmoodabadi S, Otsubo H, et al：Subcortical alterations in tissue microstructure adjacent to focal cortical dysplasia：detection at diffusion-tensor MR Imaging by using magnetoencephalographic dipole cluster localization. Radiology 251：206-215, 2009

26) Rosenow F, Lüders H：Presurgical evaluation of epilepsy. Brain　124：1683-1700, 2001

27) Palmini A, Lüders HO：Classification issues in malformations caused by abnormalities of cortical development. Neurosurg Clin N Am　13：1-16, 2002

28) Oishi M, Kameyama S, Masuda H, et al：Single and multiple clusters of magnetoencephalographic dipoles in neocortical epilepsy：significance in characterizing the epileptogenic zone. Epilepsia　47：355-364, 2006

29) RamachandranNair R, Otsubo H, Shroff MM, et al：MEG predicts outcome following surgery for intractable epilepsy in children with normal or non-focal MRI findings. Epilepsia　48：149-157, 2007

30) Roberts TP, Schmidt GL, Egeth M, et al：Electrophysiological signatures：magnetoencephalographic studies of the neural correlates of language impairment in autism spectrum disorders. Int J Psychophysiol　68：149-160, 2008

31) Papanicolaou AC, Simos PG, Breier JI, et al：Brain mechanisms for reading in children with and without dyslexia：a review of studies of normal development and plasticity. Dev Neuropsychol　24：593-612, 2003

32) Simos PG, Breier JI, Fletcher JM, et al：Cerebral mechanisms involved in word reading in dyslexic children：a magnetic source imaging approach. Cereb Cortex　10：809-816, 2000

33) Simos PG, Breier JI, Fletcher JM, et al：Brain activation profiles in dyslexic children during non-word reading：a magnetic source imaging study. Neurosci Lett　290：61-65, 2000