Role of the temporal pole in temporal lobe epilepsy seizure networks: an intracranial electrode investigation.
Role of the temporal pole in temporal lobe epilepsy seizure networks: an intracranial electrode investigation.
复制标题
颞极在颞叶癫痫发作网络中的作用：颅内电极研究。
DOI：
10.3171/2017.3.jns162821
复制
发表时间：
2018-07
影响因子：
4.1
通讯作者：
Werz MA
中科院分区：
文献类型：
--
作者：
Abel TJ;Woodroffe RW;Nourski KV;Moritani T;Capizzano AA;Kirby P;Kawasaki H;Howard M;Werz MA
临床研究表明，颞极（TP）在颞叶癫痫（TLE）发作的发生和传播中起着重要的作用，但可能未被充分认识。了解TP在TLE中的作用变得越来越重要，因为选择性手术切除医学上难治性TLE可保留TP皮质。本研究的目的是使用密集的皮层电图（ECoG）记录在接受侵入性监测的难治性TLE患者中表征TP皮质在TLE中的作用。使用定制的阵列在10名连续患者中获得慢性ECoG记录，以提供TP的密集覆盖，作为侵入性监测的一部分，以定位致痫区。所有患者最终将接受皮质杏仁核切除术。对临床记录（包括ECoG、神经影像学、神经病理学和临床结局）进行回顾性审查。在7例患者（70%）中，TP在癫痫发作时受累，7例患者（70%）中有TP的发作间期放电，1例患者早期扩散至TP。癫痫发作的TP不一定与术前神经影像学异常的TP。这些数据表明，TP皮层通常在颞叶癫痫发作网络中起着至关重要的作用。可用的神经影像学数据或发作间期放电无法预测TP的癫痫发作。这些发现说明了在TLE切除手术前彻底考虑TP的作用的重要性，特别是当考虑选择性近中切除时。
A convergence of clinical research suggests that the temporal pole (TP) plays an important, and potentially under appreciated, role in the genesis and propagation of seizures in temporal lobe epilepsy (TLE). Understanding the role of the TP in TLE is becoming increasingly important because selective surgical resections for medically intractable TLE spare TP cortex. The purpose of this study was to characterize the role of TP cortex in TLE using dense electrocorticographic (ECoG) recordings in patients undergoing invasive monitoring for medically intractable TLE. Chronic ECoG recordings were obtained in 10 consecutive patients using an array customized to provide dense coverage of the TP as part of invasive monitoring to localize the epileptogenic zone. All patients would eventually undergo cortico-amygdalohippocampectomy. A retrospective review of clinical records including ECoG, neuroimaging, neuropathology, and clinical outcomes was performed. In seven patients (70%), the TP was involved at seizure onset, in seven patients (70%) there were interictal discharges from the TP, and in one case early spread to the TP. Seizure onset in the TP did not necessarily correlate with preoperative neuroimaging abnormalities of the TP. These data demonstrate that TP cortex commonly plays a crucial role in temporal lobe seizure networks. Seizure onset from the TP would not have been predicted by available neuroimaging data or interictal discharges. These findings illustrate the importance of thoroughly considering the role of the TP prior to resective surgery for TLE, particularly when selective mesial resection is being considered.