Ictal direct current shifts contribute to defining the core ictal focus in epilepsy surgery.
Ictal direct current shifts contribute to defining the core ictal focus in epilepsy surgery.
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DOI：
10.1093/braincomms/fcac222
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发表时间：
2022
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
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确定最小和最佳的致痫区域来切除和治愈癫痫是癫痫外科的目标。为了实现这一目标，脑电分析被认为是从时空角度检测致痫灶的最直接方法。虽然发作期直流电偏移(低于1 赫兹)和发作期高频振荡(高于80 赫兹)作为良好的指标受到越来越多的关注，它们可以为传统定义的癫痫发作区域增加更具体的信息，但关于术后结果的大型队列研究仍然缺乏。这项工作旨在阐明这些额外的信息，特别是被认为反映细胞外钾浓度的发作性直流电偏移，是否真的改善了术后结果。为了评估癫痫手术的有效性，我们收集了S使用交流放大器记录的较长时间常数为10 的独特脑电数据集。61例患者(15例为内侧颞叶癫痫，46例为新皮质癫痫)在日本的5个研究所接受了侵入性的难治性癫痫的术前评估。在颅内植入电极中，发作期直流移位和发作期高频振荡的两个核心电极由董事会认证的临床医生基于统一的方法独立识别。对发作时间、持续时间和幅度(功率)等发生模式进行评估，以提取发作期直流移位和发作期高频振荡的特征。此外，我们还检查了发作期直流电漂移和发作期高频振荡的核心电极的切除率是否独立地与有利的结果相关。对53例327次癫痫发作患者进行了宽带脑电分析，对49例患者进行了预后分析。在癫痫发作区检测到的发作性直流电漂移比发作性高频振荡(92%比71%)和癫痫发作(86%比62%)更频繁。此外，在具有这两种生物标志物的患者中，发作期直流电漂移明显先于发作期高频振荡，新皮质癫痫患者发作期直流电漂移比内侧颞叶癫痫患者更频繁。最后，虽然在电极水平观察到发作期直流移位和发作期高频振荡的符合率较低(39%)，但完全切除发作期直流移位的核心区与良好的结果显著相关，类似于发作期高频振荡结果。我们的结果提供了一个概念证明，发作期直流电从发作期高频振荡的独立意义应该被认为是在癫痫手术中获得有利结果的可靠的生物标志物。此外，发作期直流电漂移和发作期高频振荡核心区的不同分布可能为癫痫的潜在机制提供新的见解，在癫痫的潜在机制中，不仅神经元，而且神经胶质细胞可能通过细胞外钾水平积极参与。Nakatani等人。收集来自多个机构的大量人类脑电数据集，以评估癫痫手术中发作期直流电变化的实用性。完全切除核心区显示发作性直流电偏移，这在新皮质癫痫中常见，独立地与良好的癫痫发作结果以及发作性高频振荡相关。
Identifying the minimal and optimal epileptogenic area to resect and cure is the goal of epilepsy surgery. To achieve this, EEG analysis is recognized as the most direct way to detect epileptogenic lesions from spatiotemporal perspectives. Although ictal direct-current shifts (below 1 Hz) and ictal high-frequency oscillations (above 80 Hz) have received increasing attention as good indicators that can add more specific information to the conventionally defined seizure-onset zone, large cohort studies on postoperative outcomes are still lacking. This work aimed to clarify whether this additional information, particularly ictal direct-current shifts which is assumed to reflect extracellular potassium concentration, really improve postoperative outcomes. To assess the usefulness in epilepsy surgery, we collected unique EEG data sets recorded with a longer time constant of 10 s using an alternate current amplifier. Sixty-one patients (15 with mesial temporal lobe epilepsy and 46 with neocortical epilepsy) who had undergone invasive presurgical evaluation for medically refractory seizures at five institutes in Japan were retrospectively enrolled in this study. Among intracranially implanted electrodes, the two core electrodes of both ictal direct-current shifts and ictal high-frequency oscillations were independently identified by board-certified clinicians based on unified methods. The occurrence patterns, such as their onset time, duration, and amplitude (power) were evaluated to extract the features of both ictal direct-current shifts and ictal high-frequency oscillations. Additionally, we examined whether the resection ratio of the core electrodes of ictal direct-current shifts and ictal high-frequency oscillations independently correlated with favourable outcomes. A total of 53 patients with 327 seizures were analyzed for wide-band EEG analysis, and 49 patients were analyzed for outcome analysis. Ictal direct-current shifts were detected in the seizure-onset zone more frequently than ictal high-frequency oscillations among both patients (92% versus 71%) and seizures (86% versus 62%). Additionally, ictal direct-current shifts significantly preceded ictal high-frequency oscillations in patients exhibiting both biomarkers, and ictal direct-current shifts occurred more frequently in neocortical epilepsy patients than in mesial temporal lobe epilepsy patients. Finally, although a low corresponding rate was observed for ictal direct-current shifts and ictal high-frequency oscillations (39%) at the electrode level, complete resection of the core area of ictal direct-current shifts significantly correlated with favourable outcomes, similar to ictal high-frequency oscillation outcomes. Our results provide a proof of concept that the independent significance of ictal direct-current shifts from ictal high-frequency oscillations should be considered as reliable biomarkers to achieve favourable outcomes in epilepsy surgery. Moreover, the different distribution of the core areas of ictal direct-current shifts and ictal high-frequency oscillations may provide new insights into the underlying mechanisms of epilepsy, in which not only neurons but also glial cells may be actively involved via extracellular potassium levels. Nakatani et al. collected large human EEG data sets from multiple institutions to assess the utility of ictal direct-current shifts in epilepsy surgery. Complete resection of the core region showing ictal direct-current shifts, commonly observed in neocortical epilepsy, independently correlated with favourable seizure outcomes, as well as ictal high-frequency oscillations.
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影响因子：
5.6
作者：
Ikeda, A;Terada, K;Shibasaki, H
通讯作者：
Shibasaki, H
影响因子：
6.2
作者：
Karus, Claudia;Mondragao, Miguel A.;Rose, Christine R.
通讯作者：
Rose, Christine R.
DOI：
10.1016/0013-4694(94)00286-t
发表时间：
1995-05-01
期刊：
ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY
影响因子：
--
作者：
ALARCON, G;BINNIE, CD;POLKEY, CE
通讯作者：
POLKEY, CE
影响因子：
14.5
作者：
Ikeda, A;Taki, W;Shibasaki, H
通讯作者：
Shibasaki, H
影响因子：
5.6
作者：
Bragin, Anatol;Claeys, Pieter;Engel, Jerome, Jr.
通讯作者：
Engel, Jerome, Jr.