Asymmetric Slow-Spike-Wave Patterns with Maximal Discharges Contralateral to MRI Lesions Predict Better Surgical Prognosis in Symptomatic Lennox-Gastaut Syndrome or Lennox-Gastaut Phenotypes
Asymmetric Slow-Spike-Wave Patterns with Maximal Discharges Contralateral to MRI Lesions Predict Better Surgical Prognosis in Symptomatic Lennox-Gastaut Syndrome or Lennox-Gastaut Phenotypes
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MRI 病变对侧最大放电的不对称慢尖波模式可预测有症状的 Lennox-Gastaut 综合征或 Lennox-Gastaut 表型的更好的手术预后
DOI：
10.1159/000504513
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发表时间：
2019-12
期刊：
影响因子：
--
通讯作者：
刘仕勇
中科院分区：
文献类型：
--
作者：
Yang MH;Liu J;Zhou YL;Yang H;Cai FC;Zempel J;Yang QW;刘仕勇
lenox - gastaut综合征（LGS）是儿童期癫痫性脑病的一种严重亚型，具有耐药性，手术预后差。然而，症状性LGS或LG表型伴结构性脑病变的脑电图（EEG）模式，包括局灶性异常或不对称慢尖波（SSW）模式，在很大程度上仍然未知。由于在症状性LGS或LG表型中，MRI病变与脑电图的侧位差异相互矛盾，因此难以准确确定癫痫病变的侧位，这对更好的手术预后至关重要。本研究旨在确定脑电图的临床特征及其与MRI病变的关系，并评估其对有症状的LGS或LG表型的手术治疗的预后价值。方法：收集24例脑电图SSW模式不对称、MRI对侧独立或对侧优势病变的有症状LGS病例，回顾性分析其临床特征。结果：在这个队列中，大多数病变是围产期的或在生命的前6个月获得的。最常见的病因是脑出血。非对称SSW和局灶散发性癫痫波（SEW）模式的LGS患者手术效果最好，Engel分级为I级。在大多数有症状的LGS或LG表型中，经常观察到不对称的SSW模式与最大放电对侧的MRI病变。在有症状性LGS或LG表型的患者中，弥漫性破坏性病变主要导致同侧头皮脑电图电压衰减，产生不对称的SSW模式。结论：我们的研究揭示了不对称SSW和MRI病变对侧的有症状的LG患者具有特殊的SEW脑电图模式。MRI与EEG侧位差异的矛盾可能是由于早期巨大破坏性病变的同侧EEG出现相对电压衰减所致。我们的研究表明，在有症状的LGS或LG表型中，独立的局灶性SEW活性保持在MRI病变的同侧可以潜在地预测更好的手术预后。
Introduction: Lennox-Gastaut syndrome (LGS) is a severe subtype of childhood-onset epileptic encephalopathy with drug-resistant and poor surgical prognosis. However, electroencephalogram (EEG) patterns of symptomatic LGS or LG phenotypes with structural brain lesions including focal abnormalities or asymmetric slow-spike-wave (SSW) patterns remain largely unknown. Due to the contradictory lateralization difference between MRI lesions and EEG pattern in symptomatic LGS or LG phenotypes, it is difficult to determine the precise lateralization of epileptic lesions, which is crucial to better surgical prognosis. This study is aim to ascertain the clinical characteristics of the EEG patterns, and its relationship with MRI lesions and to evaluate its prognostic value of surgical treatment in symptomatic LGS or LG phenotypes. Methods: Twenty-four symptomatic LGS cases with asymmetric EEG SSW patterns and contralaterally independent or contralaterally dominant MRI lesions were collected, and their clinical features were analyzed retrospectively. Results: In this cohort, most of lesions were perinatal or acquired during the first 6 months of life. The most common etiology was intracerebral hemorrhage. The LGS patients with both asymmetric SSW and focal sporadic epileptic waves (SEW) patterns showed the best surgical outcome with Engel class I level. Asymmetric SSW patterns with maximal discharges contralateral to MRI lesions were frequently observed in most of symptomatic LGS or LG phenotypes. Predominantly diffuse destructive lesions led to an attenuated voltage of ipsilateral scalp EEG producing an asymmetric SSW pattern in those patients with symptomatic LGS or LG phenotypes. Conclusions: Our study reveals a special SEW EEG pattern in symptomatic LG patients with asymmetric SSW and MRI lesions contralateral to the dominant EEG patterns. Contradictory lateralization difference between MRI and EEG probably arises from the relative voltage attenuation presenting in EEG ipsilateral to huge destructive lesions from early life. Our study suggests that the independent focal SEW activity remaining ipsilateral to the MRI lesion can potentially predict better surgical prognosis in symptomatic LGS or LG phenotypes.
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影响因子：
5.6
作者：
Camfield, Peter R.
通讯作者：
Camfield, Peter R.
影响因子：
5.6
作者：
Bourgeois, Blaise F. D.;Douglass, Laurie M.;Sankar, Raman
通讯作者：
Sankar, Raman
Lennox-Gastaut 综合征表型患者的手术治疗
影响因子：
--
作者：
Liu SY;An N;Fang X;Singh P;Oommen J;Yin Q;Yang MH;Liu Y;Liao W;Gao CQ;Yang H
通讯作者：
Yang H
影响因子：
1.7
作者：
You, Su Jeong;Lee, Jung-Kyo;Ko, Tae-Sung
通讯作者：
Ko, Tae-Sung
DOI：
--
发表时间：
2005
期刊：
--
影响因子：
--
作者：
C. Panayiotopoulos
通讯作者：
C. Panayiotopoulos