Epileptogenicity of focal malformations due to abnormal cortical development:: Direct electrocorticographic histopathologic correlations
Epileptogenicity of focal malformations due to abnormal cortical development:: Direct electrocorticographic histopathologic correlations
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DOI：
10.1046/j.1528-1157.2003.08102.x
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发表时间：
2003-01-01
期刊：
影响因子：
5.6
通讯作者：
Lüders, H
中科院分区：
文献类型：
--
作者：
Boonyapisit, K;Najm, I;Lüders, H
目的：皮质发育异常引起的畸形是医学上难治性癫痫的常见病理基础。这些病变的原位致痫性及其与组织病理学改变的关系尚不清楚。这项研究的目的是将mcd的细胞模式与局灶性皮质致痫性的表达联系起来，这是通过使用硬膜下网格直接术外皮质电图（ECoG）记录来评估的。方法：选取1997 ~ 2000年间15例经病理证实为MCD的耐药局灶性癫痫患者行硬膜下电极置入术外癫痫发作定位及皮层定位。在手术过程中，确定并分离了间期尖峰区和发作模式，以进一步进行病理表征（细胞和建筑）。病理分为三组：1型；有/没有巨大神经元的结构紊乱，IIA型；结构紊乱伴神经元畸形和IIB型；结构紊乱，神经元畸形和球囊细胞（bc）。切除的皮质组织中mcd的局灶组织病理学亚型与术外原位ECoG模式回顾性相关。结果：IIA亚型皮质区慢速重复尖峰模式的数量明显高于I型（p = 0.007）和正常病理区（p = 0.002）。15例患者中有9例发病主要发生在组织病理学类型为IIA的皮质区。所有癫痫发作均不是源于显示含有bc的MCD （IIB型）的新皮质区域。结论：本研究表明含有BCs的区域比靠近发育不良区域的癫痫发生率低。这些结果表明，bc可能具有保护作用，或者在含有发育不良病变的bc中存在严重的神经网络破坏。需要进一步的研究来阐明球囊细胞在mcd诱导的致痫性中的性质和潜在作用。
Purpose: Malformations due to abnormal cortical development (MCDs) are common pathologic substrates of medically intractable epilepsy. The in situ epileptogenicity of these lesions as well as its relation to histopathologic changes remains unknown. The purpose of this study was to correlate the cellular patterns of MCDs with the expression of focal cortical epileptogenicity as assessed by direct extraoperative electrocorticographic (ECoG) recordings by using subdural grids.Methods: Fifteen patients with drug-resistant focal epilepsy due to pathologically confirmed MCD who underwent subdural electrode placement for extraoperative seizure localization and cortical mapping between 1997 and 2000 were included in the study. Areas of interictal spiking and ictal-onset patterns were identified and separated during surgery for further pathologic characterization (cellular and architectural). Three pathologic groups were identified: type 1; architectural disorganization with/without giant neurons, type IIA; architectural disorganization with dysmorphic neurons, and type IIB; architectural disorganization, dysmorphic neurons, and balloon cells (BCs). The focal histopathologic subtypes of MCDs in cortical tissue resected were then retrospectively correlated with in situ extraoperative ECoG patterns.Results: Cortical areas with histopathologic subtype IIA showed significantly higher numbers of slow repetitive spike pattern in comparison with histopathologic type I (p = 0.007) and normal pathology (p = 0.002). The ictal onset came mainly from cortical areas with histopathologic type IIA (nine of 15 patients). None of the seizures originated from neocortical areas that showed BC-containing MCD (type IIB).Conclusions: This study shows that areas containing BCs are less epileptogenic than are closely located dysplastic regions. These results suggest a possible protective effect of BCs or a severe disruption in the neuronal networks in BCs containing dysplastic lesions. Further studies are needed to elucidate the nature and the potential role(s) of balloon cells in MCD-induced epileptogenicity.