Electrocorticography discharge patterns in patients with a cavernous hemangioma and pharmacoresistent epilepsy
Electrocorticography discharge patterns in patients with a cavernous hemangioma and pharmacoresistent epilepsy
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DOI：
10.3171/jns-07/09/0495
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发表时间：
2007-09-01
影响因子：
4.1
通讯作者：
Van Huffelen, Alexander C.
中科院分区：
文献类型：
--
作者：
Ferrier, Cyrille H.;Aronica, Eleonora;Van Huffelen, Alexander C.
Object.神经发育性病变（NDL），如胶质神经元肿瘤和皮质发育不良，产生特征性皮质电图（ECoG）放电模式。由于海绵状血管瘤，另一种先天性异常，也与耐药性癫痫有关，作者想知道他们是否表现出类似的放电模式发生在NDLs. Methods。对19例海绵状血管瘤患者和54例NDL患者的术中ECoG记录进行了连续尖峰、爆发或募集放电检查，以确定这些模式是否与病变在空间上一致。评估手术样本中小胶质细胞的相对密度和Fe 3+染色的强度。癫痫发作的结果在术后1年进行评估。海绵状血管瘤组患者发作和手术时的平均年龄高于NDL组（分别为22.5岁和36.4岁，而NDL组为10.0岁和25.2岁）。海绵状血管瘤（53%）和NDL（41%）患者的新皮层放电模式相同。在近中颞区，海绵状血管瘤患者比NDL患者更常发生同时爆发（分别为55%和10%）。海绵状血管瘤患者的同时连续尖峰与癫痫持续时间较长相关（23.5年，而无同时连续尖峰的患者为11.4年），NDL患者癫痫发作时的年龄较低（4.1岁，而无同时连续尖峰的患者为11.8岁）。在海绵状血管瘤组中，没有同时爆发与高小胶质细胞密度相关。尽管神经退行性病变患者的放电模式与预后较差相关，但铁染色强度与放电模式之间无相关性。在NDL患者中，连续的尖峰模式可能是由于发育中的大脑受到早期损伤而引起的广泛致痫区的标志;在海绵状血管瘤患者中，这种模式可能表明继发性癫痫发生。小胶质细胞可能抑制海绵状血管瘤患者的放电模式。
Object. Neurodevelopmental lesions (NDLs) such as glioneuronal tumors and cortical dysplasia produce characteristic electrocorticography (ECoG) discharge patterns. Because cavernomas, another congenital abnormality, are also associated with pharmacoresistant epilepsy, the authors wondered whether they exhibit discharge patterns similar to those occurring in NDLs.Methods. Intraoperative ECoG recordings from 19 patients with cavernomas and 54 with NDLs were reviewed for continuous spikes, bursts, or recruiting discharges and to determine whether these patterns were spatially coincident with the lesion. Relative densities of microglia and the intensity of Fe3+ staining in surgical samples were evaluated. Seizure outcome was assessed I year after surgery.Results. The mean ages at seizure onset and surgery were higher in patients in the cavernoma group than in the NDL group (22.5 and 36.4 years compared with 10.0 and 25.2 years, respectively). Neocortical discharge patterns Occurred equally in patients with either cavernomas (53%) or NDLs (41%). In the mesiotemporal area coincident bursts occurred more often in patients with cavernomas than patients with NDLs (55% compared with 10%, respectively). Coincident continuous spiking was associated with a longer duration of epilepsy in patients with cavernomas (23.5 years compared with 11.4 years for those without coincident continuous spiking) and with a lower age at seizure onset in those with NDLs (4.1 years compared with 11.8 years for those without coincident continuous spiking). In the cavernoma group the absence of coincident bursts was associated with high microglia density. There were no associations between the intensity of Fe" staining and discharge patterns, although the discharge patterns were associated with a worse outcome in patients with NDLs.Conclusions. In patients with NDLs, continuous spiking patterns may be markers of a widespread epileptogenic zone due to an early insult to the developing brain; in patients with cavernomas, such patterns may indicate secondary epileptogenesis. Microglia may inhibit discharge patterns in patients with cavernomas.