Intracranial EEG in the 21st Century
Intracranial EEG in the 21st Century
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DOI：
10.1177/1535759720934852
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发表时间：
2020-07-17
影响因子：
3.6
通讯作者：
Gotman, Jean
中科院分区：
文献类型：
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作者：
Jobst, Barbara C.;Bartolomei, Fabrice;Gotman, Jean
颅内脑电图（iEEG）一直是确定癫痫发作区（SOZ）的支柱，在考虑癫痫手术时，除了神经影像学检查外，这是一种关键的诊断程序。在许多患者中，iEEG一直是切除性癫痫手术的基础，迄今为止仍然是耐药性癫痫最成功的治疗方法。颅内EEG决定了SOZ的位置和可切除性。在21世纪，iEEG记录和植入的进步提供了多种选择。这不仅包括硬膜下电极（SEEG）和立体脑电图（SEEG）之间的选择，而且还包括微电极的植入和记录。在植入iEEG之前，特别是在磁共振成像阴性的癫痫中，应基于非侵入性方法对癫痫发作的产生和传播进行明确的假设。颅内EEG植入应由考虑癫痫网络的多学科团队进行计划。来自ESTA和SEEG的录音都有其优点和缺点。立体脑电图似乎具有较低的并发症发生率，具有临床意义，但在皮质表面的空间采样方面存在局限性。立体脑电图可以对大脑更深的区域进行采样，包括深脑沟和难以到达的区域，如小脑。要确定致痫灶，应考虑发作间期和发作期的信息。发作间期尖峰、低频减慢以及高频振荡可以告知致痫区。实际上，β/γ范围内的高频发作通常与SOZ相关，但未来结合宏电极和微电极的专门记录可能会告诉我们更高频段的发作。刺激颅内电极触发习惯性癫痫发作可以帮助识别SOZ。先进的计算方法，如确定癫痫指数和类似的措施，可以提高标准的临床解释。改进的技术来记录和解释iEEG可能在未来导致更大比例的患者在癫痫手术后无癫痫发作。
Intracranial electroencephalography (iEEG) has been the mainstay of identifying the seizure onset zone (SOZ), a key diagnostic procedure in addition to neuroimaging when considering epilepsy surgery. In many patients, iEEG has been the basis for resective epilepsy surgery, to date still the most successful treatment for drug-resistant epilepsy. Intracranial EEG determines the location and resectability of the SOZ. Advances in recording and implantation of iEEG provide multiple options in the 21st century. This not only includes the choice between subdural electrodes (SDE) and stereoelectroencephalography (SEEG) but also includes the implantation and recordings from microelectrodes. Before iEEG implantation, especially in magnetic resonance imaging -negative epilepsy, a clear hypothesis for seizure generation and propagation should be based on noninvasive methods. Intracranial EEG implantation should be planned by a multidisciplinary team considering epileptic networks. Recordings from SDE and SEEG have both their advantages and disadvantages. Stereo-EEG seems to have a lower rate of complications that are clinically significant, but has limitations in spatial sampling of the cortical surface. Stereo-EEG can sample deeper areas of the brain including deep sulci and hard to reach areas such as the insula. To determine the epileptogenic zone, interictal and ictal information should be taken into consideration. Interictal spiking, low frequency slowing, as well as high frequency oscillations may inform about the epileptogenic zone. Ictally, high frequency onsets in the beta/gamma range are usually associated with the SOZ, but specialized recordings with combined macro and microelectrodes may in the future educate us about onset in higher frequency bands. Stimulation of intracranial electrodes triggering habitual seizures can assist in identifying the SOZ. Advanced computational methods such as determining the epileptogenicity index and similar measures may enhance standard clinical interpretation. Improved techniques to record and interpret iEEG may in the future lead to a greater proportion of patients being seizure free after epilepsy surgery.