Focal ictal direct current shifts in human epilepsy as studied by subdural and scalp recording
Focal ictal direct current shifts in human epilepsy as studied by subdural and scalp recording
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DOI：
10.1093/brain/122.5.827
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发表时间：
1999-05-01
期刊：
影响因子：
14.5
通讯作者：
Shibasaki, H
中科院分区：
文献类型：
--
作者：
Ikeda, A;Taki, W;Shibasaki, H
为了进一步阐明人类癫痫发作期直流电（DC）变化的特点，我们分别对6例和3例以新皮质叶癫痫为主的患者进行了硬膜下和头皮记录（5例额叶癫痫，2例顶叶癫痫，2例颞叶癫痫），通过使用铂制成的硬膜下电极，在所有记录的癫痫发作中，85%的癫痫发作DC移位（89次癫痫发作），并且它们仅定位于一个或两个电极，在该电极处还观察到常规的初始发作EEG变化，除1例患者的1 Hz节律性活动叠加在明显的负向慢移上外，所有患者均伴有电递减模式，无论组织学诊断如何，切除皮质（包括显示DC移位的区域）后的癫痫控制是有利的，在所有记录的癫痫发作中，23%观察到头皮记录的发作缓慢移位3例患者共60次癫痫发作，与硬膜下记录的癫痫发作一样，以表面负极性为主，与电递减模式密切相关，并且在其位置上一致，似乎特别是在临床上强烈的癫痫发作时检测到头皮记录的DC偏移，而在小癫痫发作中没有观察到缓慢的偏移，结论是，至少硬膜下记录的发作缓慢的变化是临床有用的癫痫手术前，以划定更具体的致痫区，以及进一步确认传统的初始发作EEG变化和头皮记录发作缓慢偏移也具有高特异性，尽管它们的低灵敏度是要考虑的。
In order to clarify further the characteristics of ictal direct current (DC) shifts in human epilepsy, we investigated them by subdural and scalp recording in six and three patients, respectively, both having mainly neocortical lobe epilepsy (five with frontal lobe epilepsy, two with parietal lobe epilepsy and two with temporal lobe epilepsy), By using subdural electrodes made of platinum, ictal DC shifts were observed in 85% of all the recorded seizures (89 seizures) among the six patients, and they were localized to just one or two electrodes at which the conventional initial ictal EEG change was also observed, They were closely accompanied by the electrodecremental pattern in all patients except for one in whom 1 Hz rhythmic activity was superimposed on clear negative slow shifts, Seizure control after resection of the cortex, including the area showing DC shifts, was favourable irrespective of histological diagnosis, Scalp-recorded ictal slow shifts were observed in 23% of all the recorded seizures (60 seizures) among the three patients, They were, like the subdurally recorded ones, mainly surface-negative in polarity, closely related to the electrodecremental pattern and consistent in their location, It seems that scalp-recorded DC shifts were detected particularly when seizures were clinically intense, while no slow shifts were observed in small seizures, It is concluded that at least subdurally recorded ictal slow shifts are clinically useful before epilepsy surgery to delineate more specifically an epileptogenic area as well as to further confirm the conventional initial ictal EEG change, and that scalp-recorded ictal slow shifts also have high specificity although their low sensitivity is to be taken into account.