RF-ablation in periventricular heterotopia-related epilepsy
RF-ablation in periventricular heterotopia-related epilepsy
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DOI：
10.1016/j.eplepsyres.2017.07.001
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发表时间：
2018-05-01
影响因子：
2.2
通讯作者：
Tassi, Laura
中科院分区：
文献类型：
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作者：
Cossu, Massimo;Mirandola, Laura;Tassi, Laura
耐药性局灶性癫痫是一种常见的发生在灰质结节性异位症（NH）的患者，手术治疗往往被认为是在这些情况下。NH相关的致痫性由复杂的网络维持，其可能涉及结节和病灶外皮质的各种组合。因此，通常需要侵入性EEG来识别参与癫痫发作的结构。据报道，手术可能是有效的情况下，单侧病变，而双侧病例不是最佳的候选人手术成功。此外，侵犯皮质和皮质下结构接近深部结节可能会导致神经功能缺损。出于这些原因，选择性立体定向消融术与射频热凝（RFTC）已被提议作为这些患者的替代选择。特别是，RFTC可以通过使用相同的记录脑内电极植入立体脑电图（SEEG）监测，具有可靠的电临床指导的优点。最初报告了单次单侧NH凝固后癫痫发作的良好结果。随后的经验表明，根据SEEG记录的证据，在更广泛的单侧和双侧病例中也可能获得有希望的结果。在更复杂的病例中，常常需要凝固结节和受累的病灶外皮质结构。在最近报道的一个系列中，67%的患者在手术后持续无癫痫发作。然而，RFTC后癫痫发作的结果在复杂的情况下（NH加上其他畸形的皮质发育）是不如在其他模式的NH。RFTC，特别是如果SEEG评估指导下，应被视为NH相关癫痫的一线治疗选择。在不适合传统手术的情况下也可以获得满意的结果。该手术是安全的，并不妨碍在癫痫控制失败的情况下最终的切除手术。由于这些原因，在接受SEEG评价的患者中，应计划电极排列，目的是尽可能广泛地覆盖异位和病灶外区域，这可能是RFTC的目标。
Drug-resistant focal epilepsy is a common occurrence in patients with gray matter nodular heterotopia (NH), and surgical treatment is often considered in these cases. NH-related epileptogenicity is sustained by complex networks, which may involve the nodules and extralesional cortex in various combinations. Therefore, invasive EEG is usually required to identify the structures involved in seizure generation. It has been reported that surgery may be effective in cases with unilateral lesions, whereas bilateral cases are not optimal candidates for surgical success. Furthermore, violation of cortical and subcortical structures for approaching deep-seated nodules may result in neurological deficits. For these reasons, selective stereotactic ablation with radiofrequency thermocoagulation (RFTC) has been proposed as an alternative option in these patients. In particular, RFTC may be performed by using the same recording intracerebral electrodes implanted for stereo-electro-encephalo-graphy (SEEG) monitoring, with the advantage of a reliable electro-clinical guide. Excellent results on seizures have been initially reported following coagulation of single, unilateral NH. Subsequent experience has indicated that, basing on the evidence of SEEG recording, promising results may be obtained also in more extended unilateral and bilateral cases. In more complex cases, coagulation of both the nodules and of the involved extralesional cortical structures is often required. In a recently reported series, 67% of patients experienced sustained seizure freedom after the procedure. However, post RFTC seizure outcome in complex cases (NH plus other malformations of cortical development) is not as good as in other patterns of NH.RFTC, especially if guided by SEEG evaluation, should be considered as a first-line treatment option in NH-related epilepsy. Satisfactory results may be obtained also in cases not amenable to traditional surgery. The procedure is safe and does not prevent eventual resective surgery in case of failure in seizure control. For these reasons, in patients undergoing SEEG evaluation, electrode arrangement should be planned with the aim to cover as extensively as possible the heterotopic and extralesional areas, which will presumably be the targets of RFTC.