Analysis of Epileptic Discharges from Implanted Subdural Electrodes in Patients with Sturge-Weber Syndrome.
Analysis of Epileptic Discharges from Implanted Subdural Electrodes in Patients with Sturge-Weber Syndrome.
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DOI：
10.1371/journal.pone.0152992
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Arai H
中科院分区：
文献类型：
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作者：
Iimura Y;Sugano H;Nakajima M;Higo T;Suzuki H;Nakanishi H;Arai H
几乎三分之二的斯特奇-韦伯综合征（SWS）患者患有癫痫，其中一半需要手术治疗。然而，众所周知，头皮脑电图（EEG）并不能明确显示SWS患者的癫痫放电。因此，我们分析了手术治疗SWS患者的颅内硬膜下脑电图记录的间歇期和间歇期放电，以阐明这种疾病的癫痫致性。本研究纳入了5例顽固性癫痫伴SWS患者，他们在手术前植入硬膜下电极进行评估。我们通过目测检查了以下癫痫参数：癫痫发作区（SOZ）、癫痫放电的传播速度和癫痫持续时间。此外，利用脑电复杂解调法（EEG Complex Demodulation Method， CDM）对视觉检测到癫痫发作前60 s的SOZ部分频段进行功率谱分析。我们收集了5例患者的21次癫痫发作进行评估，所有的癫痫发作都始于脑膜血管瘤下的皮层。多数患者以一动不动的凝视和呼吸窘迫为发作症状。平均发作传播速度为3.1±3.6 cm/min，持续时间为19.4±33.6 min。在癫痫发作前15 s，在10 ~ 30 Hz时，在癫痫发作前5 s，在30 ~ 80 Hz时，在SOZ处检测到显著的功率谱变化。在SWS患者中，癫痫发作始于脑轻脑膜血管瘤下的皮层，癫痫发作传播缓慢，持续时间较长。CDM显示从视觉检测到癫痫发作前不久开始的β到低γ范围的癫痫发作放电。我们的脑电图结果表明，缺血是缺血性脑卒中发生和癫痫发生的主要机制。
Almost two-thirds of patients with Sturge-Weber syndrome (SWS) have epilepsy, and half of them require surgery for it. However, it is well known that scalp electroencephalography (EEG) does not demonstrate unequivocal epileptic discharges in patients with SWS. Therefore, we analyzed interictal and ictal discharges from intracranial subdural EEG recordings in patients treated surgically for SWS to elucidate epileptogenicity in this disorder. Five intractable epileptic patients with SWS who were implanted with subdural electrodes for presurgical evaluation were enrolled in this study. We examined the following seizure parameters: seizure onset zone (SOZ), propagation speed of seizure discharges, and seizure duration by visual inspection. Additionally, power spectrogram analysis on some frequency bands at SOZ was performed from 60 s before the visually detected seizure onset using the EEG Complex Demodulation Method (CDM). We obtained 21 seizures from five patients for evaluation, and all seizures initiated from the cortex under the leptomeningeal angioma. Most of the patients presented with motionless staring and respiratory distress as seizure symptoms. The average seizure propagation speed and duration were 3.1 ± 3.6 cm/min and 19.4 ± 33.6 min, respectively. Significant power spectrogram changes at the SOZ were detected at 10–30 Hz from 15 s before seizure onset, and at 30–80 Hz from 5 s before seizure onset. In patients with SWS, seizures initiate from the cortex under the leptomeningeal angioma, and seizure propagation is slow and persists for a longer period. CDM indicated beta to low gamma-ranged seizure discharges starting from shortly before the visually detected seizure onset. Our ECoG findings indicate that ischemia is a principal mechanism underlying ictogenesis and epileptogenesis in SWS.