Ictal patterns of neocortical seizures monitored with intracranial electrodes: Correlation with surgical outcome
Ictal patterns of neocortical seizures monitored with intracranial electrodes: Correlation with surgical outcome
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DOI：
10.1111/j.1528-1157.1999.tb00702.x
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发表时间：
1999-03-01
期刊：
影响因子：
5.6
通讯作者：
Ojemann, GA
中科院分区：
文献类型：
--
作者：
Kutsy, RL;Farrell, DF;Ojemann, GA
目的：许多因素已被分析，试图预测手术切除的结果与新皮质癫痫患者。我们研究了手术结果和皮层脑电图功能的新皮质发作patterns.Methods：26例新皮质癫痫患者进行了监测与硬膜下栅极电极手术前的相关性。回顾性分析了发作模式，并与三种类型的结局相关：无癫痫发作、值得改善（癫痫发作频率降低>75%）和无值得改善。结果：根据致痫灶的大小（局灶性、区域性、多灶性）;发作传播的速度和类型（快连续、慢连续、非连续）;发作活动的发作方式;参与癫痫起源的皮质部位（额叶、额顶叶等），对癫痫发作方式进行了划分。在选定的病例中，还评价了向内侧颞叶结构的扩散（通过颞下条评估）。仅一个变量显示与手术结局的统计学显著相关性（p = 0.026）：扩散类型。扩散缓慢的患者（n = 8）表现出最好的结局（5例无癫痫发作），而非连续扩散的患者（n = 5）表现出最差的结局（4例无显著改善）。快速连续传播的患者（n = 13）表现出中间outcomes.Conclusions：类型的传播发作的新皮层活动与手术结果。分析颅内记录中的发作模式可能有助于预测新皮质癫痫的手术结果。
Purpose: Numerous factors have been analyzed in attempts to predict the outcome of surgical resections in patients with neocortical epilepsy. We examined the correlation between surgical outcome and electrocorticographic features of neocortical ictal patterns.Methods: Twenty six patients with neocortical epilepsy underwent monitoring with subdural grid electrodes before surgery. Ictal patterns were analyzed retrospectively and correlated with three types of outcome: seizure free, worthwhile improvement (>75% reduction of seizure frequency), and no worthwhile improvement. The duration of follow-up was 2-5 years.Results: Ictal patterns were divided according to the size of epileptogenic zone (focal, regional, multifocal); velocity and type of seizure propagation (fast contiguous, slow contiguous, noncontiguous); pattern of the onset of ictal activity; part of the cortex involved in the origin of the seizure (frontal, frontocentroparietal, etc.). Spread to medial temporal structures (as assessed by subtemporal strips) also was evaluated in selected cases. Statistically significant correlation with surgical outcome (p = 0.026) was shown for only one variable: type of spread. Patients with slow spread (n = 8) demonstrated the best outcomes (five are seizure free), whereas patients with noncontiguous spread (n = 5) demonstrated the worst outcomes (four did not improve significantly). Patients with fast contiguous spread (n = 13) showed intermediate outcomes.Conclusions: Types of propagation of ictal neocortical activity correlate with surgical outcome. Analysis of ictal pattern during intracranial recordings may help to predict surgical outcome for neocortical epilepsy.