INTRINSIC EPILEPTOGENICITY OF HUMAN DYSPLASTIC CORTEX AS SUGGESTED BY CORTICOGRAPHY AND SURGICAL RESULTS
INTRINSIC EPILEPTOGENICITY OF HUMAN DYSPLASTIC CORTEX AS SUGGESTED BY CORTICOGRAPHY AND SURGICAL RESULTS
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DOI：
10.1002/ana.410370410
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发表时间：
1995-04-01
影响因子：
11.2
通讯作者：
KIM, HI
中科院分区：
文献类型：
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作者：
PALMINI, A;GAMBARDELLA, A;KIM, HI
皮质发育不良病变（CDyLs）通常与严重的部分性癫痫有关。我们描述了这种高度致痫性的电图对应物，表现为术中皮质电图（ECoG）直接从CDyLs记录的连续或频繁的节律性致痫性放电。这些发作性或连续性致痫性放电（I/CED）呈现以下三种模式之一：（1）重复性电图癫痫发作，（2）重复性爆发性放电，或（3）连续或准连续性节律性尖峰。34例与CDyLs相关的难治性部分性癫痫患者中有23例（67%）存在一种或多种这些模式，40例与其他类型结构病变相关的难治性部分性癫痫患者中仅1例（2.5%）存在这些模式。I/CED通常在空间上受到限制，因此与更广泛的发作间期ECoG癫痫活动形成对比，并且倾向于与磁共振成像定义的病变共定位。显示I/CED的皮质组织切除的完整性与药物难治性癫痫患者的手术结局呈正相关;即，四分之三的完全切除的患者具有良好的手术结果;相反，在那些含有I/CED的区域保持原位的患者中观察到一致的不良结果。我们的结论是，CDyLs是高度和内在的致癫痫性，术中ECoG识别这种内在致癫痫性发育不良的皮质组织是至关重要的，以决定切除的程度，最好的癫痫控制。
Cortical dysplastic lesions (CDyLs) are often associated with severe partial epilepsies. We describe the electrographic counterpart of this high degree of epileptogenicity, manifested by continuous or frequent rhythmic epileptogenic discharges recorded directly from CDyLs during intraoperative electrocorticography (ECoG). These ictal or continuous epileptogenic discharges (I/CEDs) assumed one of the following three patterns: (1) repetitive electrographic seizures, (2) repetitive bursting discharges, or (3) continuous or quasicontinuous rhythmic spiking. One or more of these patterns were present in 23 of 34 patients (67%) with intractable partial epilepsy associated with CDyLs, and in only 1 of 40 patients (2.5%) with intractable partial epilepsy associated with other types of structural lesions. I/CEDs were usually spatially restricted, thus contrasting with the more widespread interictal ECoG epileptic activity, and tended to colocalize with the magnetic resonance imaging-defined lesion. Completeness of excision of cortical tissue displaying I/CEDs correlated positively with surgical outcome in patients with medically intractable seizures; i.e., three-fourths of the patients in whom it was entirely excised had favorable surgical outcome; in contrast, uniformly poor outcome was observed in those patients in whom areas containing I/CEDs remained in situ. We conclude that CDyLs are highly and intrinsically epileptogenic, and that intraoperative ECoG identification of this intrinsically epileptogenic dysplastic cortical tissue is crucial to decide the extent of excision for best seizure control.