Ictal depth EEG and MRI structural evidence for two different epileptogenic networks in mesial temporal lobe epilepsy.
Ictal depth EEG and MRI structural evidence for two different epileptogenic networks in mesial temporal lobe epilepsy.
复制标题
DOI：
10.1371/journal.pone.0123588
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Staba RJ
中科院分区：
文献类型：
--
作者：
Memarian N;Madsen SK;Macey PM;Fried I;Engel J Jr;Thompson PM;Staba RJ
超同步（HYP）和低电压快速（LVF）活动是两个独立的发作深度脑电图发作模式，经常记录在术前MTLE患者。有证据表明，HYP和LVF发作的机制是不同的，包括海马和海马外部位的差异参与。然而，支持这两种常见癫痫发作的海马外结构改变的程度尚不清楚。在目前的研究中，术前MRI从24例HYP或LVF发作癫痫发作进行了分析，以确定皮质厚度的变化和结构变化的发作EEG的时空特性。总体而言，HYP发作的发作和初始同侧传播涉及内侧颞叶结构，而LVF发作涉及内侧和外侧颞叶以及眶额皮质。MRI分析发现皮质厚度的减少与癫痫持续时间的延长有关。然而，在HYP发作的患者中，受影响最大的区域位于每个半球的内侧表面，包括海马旁区域和扣带回，而在LVF发作的患者中，前颞叶和眶额皮质的外侧表面显示出最大的影响。大多数HYP发作的患者在切除手术后无复发，而较高比例的LVF发作的患者仅得到值得改善。我们的研究结果证实了这一观点，即反复发作引起皮质厚度的渐进性变化，并提供有关两个不同的癫痫网络负责MTLE的结构基础的信息。一种是通过HYP发作确定的，主要涉及海马，并且与标准化前内侧颞叶切除术后的良好结局相关，而另一种也涉及外侧颞叶和眶额皮质，并且在该手术后较少发生无创伤手术结局。这些结果表明，更广泛的定制切除可能需要与第二种类型的MTLE患者。
Hypersynchronous (HYP) and low voltage fast (LVF) activity are two separate ictal depth EEG onsets patterns often recorded in presurgical patients with MTLE. Evidence suggests the mechanisms generating HYP and LVF onset seizures are distinct, including differential involvement of hippocampal and extra-hippocampal sites. Yet the extent of extra-hippocampal structural alterations, which could support these two common seizures, is not known. In the current study, preoperative MRI from 24 patients with HYP or LVF onset seizures were analyzed to determine changes in cortical thickness and relate structural changes to spatiotemporal properties of the ictal EEG. Overall, onset and initial ipsilateral spread of HYP onset seizures involved mesial temporal structures, whereas LVF onset seizures involved mesial and lateral temporal as well as orbitofrontal cortex. MRI analysis found reduced cortical thickness correlated with longer duration of epilepsy. However, in patients with HYP onsets, the most affected areas were on the medial surface of each hemisphere, including parahippocampal regions and cingulate gyrus, whereas in patients with LVF onsets, the lateral surface of the anterior temporal lobe and orbitofrontal cortex showed the greatest effect. Most patients with HYP onset seizures were seizure-free after resective surgery, while a higher proportion of patients with LVF onset seizures had only worthwhile improvement. Our findings confirm the view that recurrent seizures cause progressive changes in cortical thickness, and provide information concerning the structural basis of two different epileptogenic networks responsible for MTLE. One, identified by HYP ictal onsets, chiefly involves hippocampus and is associated with excellent outcome after standardized anteromedial temporal resection, while the other also involves lateral temporal and orbitofrontal cortex and a seizure-free surgical outcome occurs less after this procedure. These results suggest that a more extensive tailored resection may be required for patients with the second type of MTLE.
登录
查看更多内容
影响因子：
5.6
作者：
Bonilha L;Edwards JC;Kinsman SL;Morgan PS;Fridriksson J;Rorden C;Rumboldt Z;Roberts DR;Eckert MA;Halford JJ
通讯作者：
Halford JJ
影响因子：
9.9
作者：
Bernasconi, N;Natsume, J;Bernasconi, A
通讯作者：
Bernasconi, A
影响因子：
5.6
作者：
Bragin, Anatol;Claeys, Pieter;Engel, Jerome, Jr.
通讯作者：
Engel, Jerome, Jr.
影响因子：
3.7
作者：
Coan AC;Campos BM;Yasuda CL;Kubota BY;Bergo FP;Guerreiro CA;Cendes F
通讯作者：
Cendes F
影响因子：
5.6
作者：
Fahoum, Firas;Lopes, Renaud;Gotman, Jean
通讯作者：
Gotman, Jean