Analysis of initial slow waves (ISWs) at the seizure onset in patients with drug resistant temporal lobe epilepsy
Analysis of initial slow waves (ISWs) at the seizure onset in patients with drug resistant temporal lobe epilepsy
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DOI：
10.1111/j.1528-1167.2007.01149.x
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发表时间：
2007-10-01
期刊：
影响因子：
5.6
通讯作者：
Engel, Jerome, Jr.
中科院分区：
文献类型：
--
作者：
Bragin, Anatol;Claeys, Pieter;Engel, Jerome, Jr.
原理：本研究的目的是分析难治性颞叶癫痫患者癫痫发作时的初始慢波（ISW）。ISWs是一种特殊类型的发作性EEG模式，其特征在于癫痫发作时的慢波，随后是低电压快速activity.Methods：对来自UCLA医院（美国）的14名患者和来自根特大学医院（比利时）的10名患者进行了调查，植入了深度和网格电极用于定位致痫区。分析了UCLA组61例癫痫发作和根特组30例癫痫发作。14名UCLA和7名根特患者在癫痫发作时有ISW。ISW的持续时间在0.3至6.0 s之间变化，最大振幅在0.2至1.4 mV之间变化。14例UCLA患者中有3例（占癫痫发作的30%）的ISW在位于杏仁核、海马或内嗅皮层的最深接触处具有一致的正极性，而在这些脑区（ISWs I）之外则具有相反的极性。14名UCLA患者（70%的癫痫发作）的I I中的ISWs在最深电极处具有负极性，并且其幅度朝向位于白色物质或新皮质（ISWs 2）中的记录触点增加。来自7名根特患者的所有ISW在深度接触（ISWs 2）中为阴性，在皮质表面的网格电极上为阳性。ISWs 1与发作时的EEG棘波和10-20 Hz正弦活动振幅增加相关。相比之下，ISWs 2与EEG振幅的抑制相关，频率在20-50 Hz范围内增加，并且在发作时没有EEG尖峰。多单位神经元活动在发作间期的棘波放电中表现出较强的同步性，而在ISWs 2期的多单位同步性不明显。结论：ISWs 1期的EEG棘波和相位反转的存在表明该类型的癫痫发作可能是由神经元超同步放电触发的，而ISWs 2期的癫痫发作可能是由不同的机制触发的，可能是非神经元的。
Rationale: The goal of this study is to analyze initial slow waves (ISWs) at seizure onset in patients with refractory temporal lobe epilepsy. ISWs are a specific type of ictal EEG pattern characterized by a slow wave at the seizure onset followed by low voltage fast activity.Methods: Investigations were carried out on 14 patients from the UCLA hospital (USA) and 10 from the Ghent University Hospital (Belgium) implanted with depth and grid electrodes for localization of the epileptogenic zone.Results: Sixty-one seizures in the UCLA group and 30 seizures in the Ghent group were analyzed. Fourteen UCLA and seven Ghent patients had ISWs at seizure onset. The duration of ISWs varied between 0.3 to 6.0 s and maximum amplitude varied from 0.2 to 1.4 mV. ISWs in three of 14 UCLA patients (30% of seizures) had a consistent positive polarity at the deepest contacts that were located in the amygdala, hippocampus, or entorhinal cortex and reversed polarity outside of these brain areas (ISWs I). ISWs in I I of 14 UCLA patients (70% of seizures) had negative polarity at the deepest electrodes and their amplitude increased toward the recording contacts located in the white matter or neocortex (ISWs2). All ISWs from the seven Ghent patients were negative in the depth contacts (ISWs2) and positive on grid electrodes at the cortical surface. ISWs1 were associated with EEG spikes at the onset and on increase in amplitude of 10-20 Hz sinusoidal activity. In contrast, ISWs2 were associated with suppression of EEG amplitude, an increase in frequency in the range of 20-50 Hz, and did not have EEG spikes at the onset. Multiunit neuronal activity showed strong synchronization of neuronal discharges during interictal spikes, but multiunit synchronization was not obvious during ISWs2.Conclusion: The existence of EEG spikes and phase reversal with ISWs1 indicates this type of seizure may be triggered by hypersynchronous neuronal discharges; however, seizures with ISWs2 at the onset may be triggered by different mechanisms, perhaps nonneuronal.