Prognostic value of insular lobe involvement in temporal lobe epilepsy: A stereoelectroencephalographic study
Prognostic value of insular lobe involvement in temporal lobe epilepsy: A stereoelectroencephalographic study
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DOI：
10.1111/epi.12260
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发表时间：
2013-09-01
期刊：
影响因子：
5.6
通讯作者：
Kahane, Philippe
中科院分区：
文献类型：
--
作者：
Blauwblomme, Thomas;David, Olivier;Kahane, Philippe
目的：颞叶癫痫的前颞叶切除术失败引发了岛叶皮质是否参与这些癫痫发作的问题。由于通过侵入性脑电图（EEG）记录探索岛叶存在困难，仅有少数研究得以开展，这个问题仍未得到解答。
方法：在此，我们研究了17例因耐药性颞叶癫痫接受手术的患者，这些患者使用脑内电极进行了探查，至少有一个电极与岛叶共面。我们分析了从颞叶结构到岛叶的癫痫发作传播模式及其对手术结果的影响。我们对个体病例的岛叶致痫性进行了客观测量，并对术后无癫痫发作的患者和其他患者进行了分组分析。
主要发现：所有颞叶癫痫发作都传播到岛叶皮质，在颞叶中外侧癫痫发作的情况下传播延迟更短，从而支持了边缘旁网络的存在。岛叶皮质的致痫性不是手术结果的预后因素。
意义：岛叶参与颞叶癫痫发作本身不是手术结果的预后因素。预后可能与更大的致痫区相关，而我们的立体脑电图空间采样可能低估了这些致痫区。
Purpose: Failure of anterior temporal lobectomy for temporal lobe epilepsy has raised the question of insular cortex involvement in these seizures. Because of difficulties in exploring the insula with invasive electroencephalography (EEG) recordings, only few studies have been performed and this question remains unanswered.Methods: Here, we studied 17 patients who underwent surgery for drug-resistant temporal lobe epilepsy, explored with intracerebral electrodes, with at least one electrode coplanar to the insula. We analyzed seizure propagation patterns from temporal lobe structures to the insula, and their effect on outcome. We used an objective measure of the epileptogenicity of the insula for individual cases and group analysis between patients who were seizure-free after surgery and the others.Key Findings: All temporal lobe seizures propagated to the insular cortex, with a shorter propagation delay in the case of mesiolateral temporal lobe seizures, thus supporting the existence of a perilimbic network. Epileptogenicity of the insular cortex was not a prognostic factor for outcome after surgery.Significance: Insular involvement in temporal lobe seizure is not per se a prognostic factor for surgical outcome. Prognosis may be correlated with larger epileptogenic zones that our stereoelectroencephalography spatial sampling could have underestimated.