Early seizure spread and epilepsy surgery: A systematic review.
Early seizure spread and epilepsy surgery: A systematic review.
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作者：
Andrews JP;Ammanuel S;Kleen J;Khambhati AN;Knowlton R;Chang EF
癫痫外科手术中的一个基本问题是如何划定必须切除的皮质边缘，以实现癫痫的自由发作。是否必须切除发作早期表现出癫痫活动的区域，以及必须切除哪些区域，以避免术后癫痫复发，这是一个正在进行的研究领域。虽然发作初期的癫痫发作扩散动力学常常与术后结果相关，但对早期发作的扩散没有一致的定义，也没有将癫痫发作扩散与手术后发作结果联系起来的现有文献的简明摘要。本研究旨在总结癫痫发作扩散与术后癫痫发作结局之间的联系，并为早期癫痫发作扩散的定量评估提供一个框架。根据PRISMA指南进行了系统审查。Medline搜索确定了临床研究，报告了通过颅内电极测量的癫痫蔓延数据，至少有10名受试者，并在英文文献中报告了从1990年到2019年至少一年的术后结果。研究评估了对一个基本假设的支持：早期癫痫发作扩散的区域代表具有癫痫产生潜力的皮质。这项研究共产生了4562项研究。15项研究符合纳入标准。有7项研究支持最初的假设。用于描述癫痫发作扩散的方法和指标是不同的。与癫痫发作结果相关的癫痫发作蔓延的时间范围为1-14秒，大型、设计良好的回顾研究指出，3-10秒最有可能提供有意义的术后癫痫发作自由相关因素。电生理学癫痫发作蔓延和癫痫发作发生的可能性之间的复杂关系需要进一步阐明。需要前瞻性的队列研究或试验来评估癫痫手术在癫痫发作的前3-10秒内所涉及的皮质。
A fundamental question in epilepsy surgery is how to delineate the margins of cortex that must be resected to result in seizure freedom. Whether and which areas showing seizure activity early in ictus must be removed to avoid post-operative recurrence of seizures is an area of ongoing research. While seizure spread dynamics in the initial seconds of ictus are often correlated with postoperative outcome, there is no consensus definition of early spread, nor is there a concise summary of the existing literature linking seizure spread to post-surgical seizure outcomes. The present study is intended to summarize the literature linking seizure spread to postoperative seizure outcome and provide a framework for quantitative assessment of early seizure spread. A systematic review was carried out according to PRISMA guidelines. A Medline search identified clinical studies reporting data on seizure spread measured by intracranial electrodes, having at least 10 subjects and reporting at least 1-year postoperative outcome in the English literature from 1990 to 2019. Studies were evaluated regarding support for a primary hypothesis: Areas of early seizure spread represent cortex with seizure-generating potential. The search yielded 4562 studies. 15 studies met inclusion criteria. 7 studies supported the primary hypothesis. The methods and metrics used to describe seizure spread were heterogenous. The timeframe of seizure spread associated with seizure outcome ranged from 1 – 14 seconds, with large, well-designed, retrospective studies pointing to 3 – 10 seconds as most likely to provide meaningful correlates of postoperative seizure freedom. The complex correlation between electrophysiologic seizure spread and the potential for seizure generation needs further elucidation. Prospective cohort studies or trials are needed to evaluate epilepsy surgery targeting cortex involved in the first 3–10 seconds of ictus.
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