ICTAL EEG WAVE FORMS FROM EPIDURAL ELECTRODES PREDICTIVE OF SEIZURE CONTROL AFTER TEMPORAL LOBECTOMY
ICTAL EEG WAVE FORMS FROM EPIDURAL ELECTRODES PREDICTIVE OF SEIZURE CONTROL AFTER TEMPORAL LOBECTOMY
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DOI：
10.1016/0013-4694(92)90116-y
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发表时间：
1992-10-01
期刊：
影响因子：
--
通讯作者：
HURST, DC
中科院分区：
文献类型：
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作者：
FAUGHT, E;KUZNIECKY, RI;HURST, DC
分析了28例患者植入硬膜外条电极记录的140次复杂部分性癫痫发作的发作波形特征-频率、空间分布和持续时间。影像学检查无异常。所有患者均行双侧电极置入、单侧癫痫发作、颞叶切除术，术后平均随访33个月。16名患者（57%）不再出现复杂部分性癫痫发作：12名患者的癫痫发作频率至少降低了50%，但并非完全无癫痫发作，唯一的预测因素是存在α或β范围内的低电压快速活动（LVF），局限于一个脑回。14/16例无尿潴留者出现上述现象，2/12例无尿潴留者出现上述现象（P < 0.001）。随着癫痫发作的进展，LVF的振幅增加，传播，并减慢到θ波范围。这些波形的逐步判别分析，考虑到他们是否是本地化或区域，发现频率和本地化是手术后预后的关键。仅存在局部癫痫发作是不可靠的，除非考虑到波形。硬膜外颞下电极在癫痫发作时超过8 Hz的良好局部化节律活动预测手术成功。较慢的节律意味着从癫痫发作开始在空间和时间上有较大的分离。
Ictal wave form characteristics - frequency, spatial distribution, and duration - were analyzed for 140 complex partial seizures recorded from epidural strip electrodes implanted in 28 patients. None had abnormalities on imaging studies. All had bilateral electrode placements, unilateral seizure onsets, temporal lobectomies, and were followed for a mean of 33 months postoperatively. Sixteen patients (57%) became free of complex partial seizures: 12 had reductions in seizure frequency of at least 50% but were not seizure-free.The only predictor of the seizure-free state was the presence of low voltage fast activity (LVF), in the alpha or beta ranges, localized to one gyrus. This phenomenon occurred in 14/16 seizure-free patients, 2/12 of others (P < 0.001). As seizures progressed, LVF typically increased in amplitude, propagated, and slowed into the theta range.Wave forms were classified into 8 categories based upon their frequency and morphology. Stepwise discriminant analysis of these wave forms, with consideration of whether they were localized or regional, revealed that both frequency and localization were critical for the post-surgical prognosis. The mere presence of a localized seizure onset was unreliable unless the wave form was taken into account.Well-localized rhythmic activity over 8 Hz at seizure onset from epidural subtemporal electrodes predicts surgical success. Slower rhythms imply greater separation in space and time from seizure onset.