Removing interictal fast ripples on electrocorticography linked with seizure freedom in children
Removing interictal fast ripples on electrocorticography linked with seizure freedom in children
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DOI：
10.1212/wnl.0b013e3181fc27d0
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发表时间：
2010-11-09
期刊：
影响因子：
9.9
通讯作者：
Mathern, G. W.
中科院分区：
文献类型：
--
作者：
Wu, J. Y.;Sankar, R.;Mathern, G. W.
背景：用慢性颅内电极检测到的快波（FR，250-500 Hz）被认为是癫痫发生的生物标志物。本研究确定是否切除FR包含新皮质记录在术中皮层电图（ECoG）与术后癫痫发作的自由，在儿科患者大多是outrestemporal insulines.Methods：FR进行了回顾性分析，在30个连续的儿科病例。ECoG记录在2,000 Hz的采样率和视觉检查FR，与审查者不知情的切除和outcome.Results：平均年龄在手术是9.1 +/- 6.7岁，ECoG持续时间为11.8 +/- 8.1分钟，术后随访27 +/- 4个月。6例远处或广泛病变的ECoG未检测到FR。在24例患者的ECoG中确定了FR发作（n = 273），64%的FR独立于棘波、尖波、电压衰减和阵发性快速活动。在这24名儿童中，19名患者的含FR皮质被切除，所有患者均无复发，包括1名第二次手术后的儿童。其余5例患儿FR切除不完全，术后均持续癫痫发作。在2例ECoG中，电图癫痫发作的位置与FR位置相匹配。结论：80%的癫痫患儿术中ECoG检测到FR，完整切除FR皮质与术后无癫痫发作密切相关。这些发现支持了这样的观点，即发作间期FR是癫痫发生的极好的替代标记物，可以在短暂的ECoG期间记录，并可用于指导未来的儿童手术切除。神经病学（R）2010;75：1686-1694
Background: Fast ripples (FR, 250-500 Hz) detected with chronic intracranial electrodes are proposed biomarkers of epileptogenesis. This study determined whether resection of FR-containing neocortex recorded during intraoperative electrocorticography (ECoG) was associated with postoperative seizure freedom in pediatric patients with mostly extratemporal lesions.Methods: FRs were retrospectively reviewed in 30 consecutive pediatric cases. ECoGs were recorded at 2,000 Hz sampling rate and visually inspected for FR, with reviewer blinded to the resection and outcome.Results: Average age at surgery was 9.1 +/- 6.7 years, ECoG duration was 11.8 +/- 8.1 minutes, and postoperative follow-up was 27 +/- 4 months. FRs were undetected in 6 ECoGs with remote or extensive lesions. FR episodes (n = 273) were identified in ECoGs from 24 patients, and in 64% FRs were independent of spikes, sharp waves, voltage attenuation, and paroxysmal fast activity. Of these 24 children, FR-containing cortex was removed in 19 and all became seizure-free, including 1 child after a second surgery. The remaining 5 children had incomplete FR resection and all continued with seizures postoperatively. In 2 ECoGs, the location of electrographic seizures matched FR location. FR-containing cortex was found outside of MRI and FDG-PET abnormalities in 6 children.Conclusion: FRs were detected during intraoperative ECoG in 80% of pediatric epilepsy cases, and complete resection of FR cortex correlated with postoperative seizure freedom. These findings support the view that interictal FRs are excellent surrogate markers of epileptogenesis, can be recorded during brief ECoG, and could be used to guide future surgical resections in children. Neurology(R) 2010;75:1686-1694