Ictal spread of medial temporal lobe seizures with and without secondary generalization: an intracranial electroencephalography analysis.
Ictal spread of medial temporal lobe seizures with and without secondary generalization: an intracranial electroencephalography analysis.
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DOI：
10.1111/epi.12505
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发表时间：
2014-02
期刊：
影响因子：
5.6
通讯作者：
Blumenfeld H
中科院分区：
文献类型：
--
作者：
Yoo JY;Farooque P;Chen WC;Youngblood MW;Zaveri HP;Gerrard JL;Spencer DD;Hirsch LJ;Blumenfeld H
癫痫的继发性全身化对患者的安全和生活质量具有破坏性后果。这项颅内EEG（icEEG）研究的目的是研究持续局灶性与继发性全身性颞叶癫痫发作的发作和传播模式的差异，以更好地了解继发性全身性发作的机制。分析了9例符合以下标准的患者的39次癫痫发作：1）icEEG-视频监测至少有1次继发性全身强直阵挛性癫痫发作（GTC），2）病理证实的海马硬化，3）前内侧颞叶切除术后至少1年无癫痫发作。通过对视频的行为分析，将癫痫发作分为局灶性或继发性全身性。通过分析icEEG比较发作和传播模式。我们获得了22个局灶性癫痫发作无全身化（FS）和17个GTC的数据。FS和GTC之间的癫痫发作模式没有差异，但后来的传播有差异。除1例患者7次发作（6次FS，1次GTC）以明显轮廓的θ活动开始外，所有发作均以低电压快速活动开始。39次发作中15次发作始于海马，24次发作（包括1例无海马接触的患者的6次发作）始于内侧颞叶其他区域。我们观察到参与或更突出的激活后外侧颞区GTC传播到其他皮质区域之前，与FS没有参与或不太突出的激活后外侧颞皮质。临床继发性泛化时不涉及枕骨接触。后外侧颞叶皮层可能是控制内侧颞叶癫痫发作向其他皮层区域传播的重要“门户”。识别局灶性癫痫继发性全身化的机制可能会导致改善治疗以限制癫痫蔓延。
Secondary generalization of seizures has devastating consequences for patient safety and quality of life. The aim of this intracranial EEG (icEEG) study was to investigate the differences in onset and propagation patterns of temporal lobe seizures that remained focal vs. those with secondary generalization in order to better understand the mechanism of secondary generalization. A total of 39 seizures were analyzed in 9 patients who met the following criteria: 1) icEEG-video monitoring with at least 1 secondarily generalized tonic clonic seizure (GTC), 2) pathologically proven hippocampal sclerosis, and 3) no seizures for at least 1 year after anteromedial temporal lobe resection. Seizures were classified as focal or secondary generalized by behavioral analysis of video. Onset and propagation patterns were compared by analysis of icEEG. We obtained data from 22 focal seizures without generalization (FS), and 17 GTC. Seizure onset patterns did not differ between FS and GTCs, but there were differences in later propagation. All seizures started with low voltage fast activity except 7 seizures in one patient (6 FS, 1 GTC), which started with sharply contoured theta activity. 15 of 39 seizures started from the hippocampus and 24 seizures (including 6 seizures in a patient without hippocampal contacts) started from other medial temporal lobe areas. We observed involvement or more prominent activation of the posterior-lateral temporal regions in GTCs prior to propagation to the other cortical regions, vs. FS which had no involvement or less prominent activation of the posterior lateral temporal cortex. Occipital contacts were not involved at the time of clinical secondary generalization. The posterior-lateral temporal cortex may serve as an important “gateway” controlling propagation of medial temporal lobe seizures to other cortical regions. Identifying the mechanisms of secondary generalization of focal seizures may lead to improved treatments to confine seizure spread.
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影响因子：
3.4
作者：
Constable RT;Scheinost D;Finn ES;Shen X;Hampson M;Winstanley FS;Spencer DD;Papademetris X
通讯作者：
Papademetris X
影响因子：
2.2
作者：
Enatsu, Rei;Jin, Kazutaka;Nair, Dileep R.
通讯作者：
Nair, Dileep R.
影响因子：
2.6
作者：
Rektor, Ivan;Zakopcan, Jozef;Novak, Zdenek
通讯作者：
Novak, Zdenek
影响因子：
2.4
作者：
Napolitano, Cayetano E.;Orriols, Miguel A.
通讯作者：
Orriols, Miguel A.
影响因子：
5.3
作者：
Trevelyan, Andrew J.;Sussillo, David;Yuste, Rafael
通讯作者：
Yuste, Rafael