Electroclinical features of insulo-opercular epilepsy: an SEEG and PET study
Electroclinical features of insulo-opercular epilepsy: an SEEG and PET study
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岛盖癫痫的电临床特征：SEEG 和 PET 研究
DOI：
10.1002/acn3.789
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发表时间：
2019-07-01
影响因子：
5.3
通讯作者：
Zhang, Kai
中科院分区：
文献类型：
--
作者：
Wang, Xiu;Hu, Wenhan;Zhang, Kai
目的报告岛盖区癫痫术前评估的临床经验。通过对PET显像和立体脑电图（SEEG）信号的定量分析，总结其临床电图特征。方法回顾性分析22例SEEG诊断为岛叶和（或）岛盖皮质局灶性癫痫患者的临床资料。详细分析术前无创资料。然后将患者的发作间期PET数据与健康对照组进行统计学比较，以确定发作间期低代谢网络。计算发作SEEG信号的致痫性指数（EI），以确定癫痫发作开始时的扩散区域。结果面部和/或颈部的局灶性强直性发作（16/22，73%）是最常见的早期客观体征。癫痫发作间期和发作期头皮脑电图的癫痫放电大多呈同侧裂周分布。发作间期PET的统计学分析显示，岛叶、中央盖、辅助运动区、中扣带回皮质、双侧尾状核和壳核的代谢明显降低。根据EI分析，岛盖癫痫可分为岛盖癫痫（50%）、岛盖癫痫（41%）和岛叶皮质癫痫（9%）。岛盖区癫痫的临床诊断具有挑战性，因为其复杂的发作症状和头皮脑电图的非定位放电。一个共同的低代谢网络，涉及岛盖皮质，内侧额叶皮质和皮质下核可能参与岛盖癫痫网络的组织。此外，定量SEEG分析表明，纯粹的岛叶癫痫是罕见的，岛叶和岛盖皮质之间的密切联系需要SEEG植入来定义致痫区。
Objective To report clinical experience with presurgical evaluation in patients with insulo-opercular epilepsy. Quantitative analysis on PET imaging and stereoelectroencephalography (SEEG) signals was used to summarize their electroclinical features. Methods Twenty-two patients with focal epilepsy arising from the insular and/or opercular cortex according to SEEG were retrospectively analyzed. Presurgical noninvasive data were analyzed in detail. Interictal PET data of patients were then statistically compared with those of healthy controls to identify the interictal hypometabolic network. The epileptogenicity index (EI) of ictal SEEG signal was computed to identify areas of spread at the beginning of seizure onset. Results Focal tonic seizures of the face and/or neck (16/22, 73%) were the most prevalent early objective signs. Epileptic discharges in the interictal and ictal scalp-EEG mostly showed an ipsilateral perisylvian distribution. Statistical analysis of interictal PET showed significant hypometabolism in the insular lobe, central operculum, supplementary motor area, middle cingulate cortex, bilateral caudate nuclei, and putamen. According to the EI analysis, insulo-opercular epilepsy could be classified as insulo-opercular epilepsy (50%), opercular epilepsy (41%), and insular cortex epilepsy (9%). Significance Clinical diagnosis of insulo-opercular epilepsy is challenging because of its complex seizure semiology and nonlocalizing discharges on scalp-EEG. A common hypometabolic network involving the insulo-opercular cortex, mesial frontal cortex and subcortical nuclei may be involved in the organization of the insulo-opercular epilepsy network. Furthermore, quantified SEEG analysis suggested that pure insular epilepsy is rare, and the close connection between insular and opercular cortex necessitates SEEG implantation to define the epileptogenic zone.