Intracranial electroencephalography seizure onset patterns and surgical outcomes in nonlesional extratemporal epilepsy.
Intracranial electroencephalography seizure onset patterns and surgical outcomes in nonlesional extratemporal epilepsy.
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DOI：
10.3171/2008.8.jns17643
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发表时间：
2009-06
影响因子：
4.1
通讯作者：
Worrell GA
中科院分区：
文献类型：
--
作者：
Wetjen NM;Marsh WR;Meyer FB;Cascino GD;So E;Britton JW;Stead SM;Worrell GA
正常磁共振成像（非病变）和医学上难治性颞外癫痫的患者在癫痫手术后的不良预后中占不成比例的比例。在本文中，作者探讨了颅内脑电图（iEEG）在识别手术候选人中的作用。在1992年至2002年间，51例连续的磁共振成像结果正常的颞外癫痫患者接受了颅内电极监测。颅内电极的植入是通过癫痫符号学、间歇期和间歇期头皮脑电图、SPECT和一些患者的PET研究来确定的。从Mayo Rochester癫痫手术数据库中提取患者手术时的人口统计数据、电极植入的大叶定位、随访时间和Engel结果评分。本研究对脑电图记录进行了盲法独立审查。51例接受iEEG的患者中有31例（61%）最终接受了癫痫切除术。在31例接受癫痫手术的患者中，28例（90.3%）有足够的随访（bbb10 - 1年）、癫痫发作频率和脑电图记录信息。28例患者中有26例（92.9%）行额叶切除术，2例行顶叶切除术。手术治疗组癫痫发作时最常见的脑电图模式为局灶性高频放电（28例患者中有15例[53.6%]）。28例手术患者中10例（35.7%）无癫痫发作。14例（50%）有Engel I级结果，总体而言，17例（60.7%）有显著改善（Engel I级和IIAB，癫痫发作减少≥80%）。癫痫发作时局灶性高频振荡与Engel I级手术结果相关（14例患者中有12例[85.7%],p = 0.02），而在预后不佳组中不常见（14例患者中有3例[21.4%]）。脑电图上癫痫发作时的局灶高频振荡（bbb20 Hz）可以识别癫痫手术后可能有Engel I级预后的非病变颞外癫痫患者。颅内监测前非病变颞叶癫痫的预后前景很差（51例患者中14例[27.5%]）。然而，iEEG可以进一步对患者进行分层，并帮助识别那些术后更有可能出现Engel I级结果的患者。
Patients with normal MR imaging (nonlesional) findings and medically refractory extratemporal epilepsy make up a disproportionate number of nonexcellent outcomes after epilepsy surgery. In this paper, the authors investigated the usefulness of intracranial electroencephalography (iEEG) in the identification of surgical candidates. Between 1992 and 2002, 51 consecutive patients with normal MR imaging findings and extratemporal epilepsy underwent intracranial electrode monitoring. The implantation of intracranial electrodes was determined by seizure semiology, interictal and ictal scalp EEG, SPECT, and in some patients PET studies. The demographics of patients at the time of surgery, lobar localization of electrode implantation, duration of follow-up, and Engel outcome score were abstracted from the Mayo Rochester Epilepsy Surgery Database. A blinded independent review of the iEEG records was conducted for this study. Thirty-one (61%) of the 51 patients who underwent iEEG ultimately underwent resection for their epilepsy. For 28 (90.3%) of the 31 patients who had epilepsy surgery, adequate information regarding follow-up (> 1 year), seizure frequency, and iEEG recordings was available. Twenty-six (92.9%) of 28 patients had frontal lobe resections, and 2 had parietal lobe resections. The most common iEEG pattern at seizure onset in the surgically treated group was a focal high-frequency discharge (in 15 [53.6%] of 28 patients). Ten (35.7%) of the 28 surgically treated patients were seizure free. Fourteen (50%) had Engel Class I outcomes, and overall, 17 (60.7%) had significant improvement (Engel Class I and IIAB with ≥ 80% seizure reduction). Focal high-frequency oscillation at seizure onset was associated with Engel Class I surgical outcome (12 [85.7%] of 14 patients, p = 0.02), and it was uncommon in the nonexcellent outcome group (3 [21.4%] of 14 patients). A focal high-frequency oscillation (> 20 Hz) at seizure onset on iEEG may identify patients with nonlesional extratemporal epilepsy who are likely to have an Engel Class I outcome after epilepsy surgery. The prospect of excellent outcome in nonlesional extratemporal lobe epilepsy prior to intracranial monitoring is poor (14 [27.5%] of 51 patients). However, iEEG can further stratify patients and help identify those with a greater likelihood of Engel Class I outcome after surgery.