Fast ripple analysis in human mesial temporal lobe epilepsy suggests two different seizure-generating mechanisms
Fast ripple analysis in human mesial temporal lobe epilepsy suggests two different seizure-generating mechanisms
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DOI：
10.1016/j.nbd.2019.03.030
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发表时间：
2019-07-01
影响因子：
6.1
通讯作者：
Gotman, Jean
中科院分区：
文献类型：
--
作者：
Schoenberger, Jan;Frauscher, Birgit;Gotman, Jean
目的：内侧颞叶癫痫 (MTLE) 超同步 (HYP) 和低电压快速 (LVF) 发作的区别已经明确，但对个体癫痫发作和患者进行分类通常具有挑战性。实验工作表明 HYP 与快速纹波 (250-500 Hz) 以及 LW 与纹波 (80-250 Hz) 密切相关。我们的目的是调查高频振荡分析是否有助于表征人类 MTLE 患者癫痫发作的发生过程。方法：我们回顾性比较了 10 名和 6 名连续 MTLE 患者的 19 次 HYP 和 14 次 LW 发作临床癫痫发作，并确定了各自模式的优势。选择来自癫痫发作区域的五秒间隔的立体定向脑电图，每个代表 HYP 和 LW 的发作、相应的发作前时期，以及在 HYP 发作的大峰值之后经常遵循的类似 LW 的模式。 结果：HYP 癫痫发作的发作前快速波纹密度和速率高于 LW 癫痫发作 (p < .05)。初始发作段也发现了这种关联 (p < .001)。此外，在 HYP 尖峰后的类 LVF 模式期间，快速纹波密度和速率高于没有事先 HYP 的 LVF 期间 (p < .01)。相比之下，波纹密度和速率没有显着差异 (p > .05)。与没有先于 HYP 的 LW 相比，在 HYP 尖峰后的 LW 样模式中，快速纹波 (p < .01) 和纹波 (p < .001) 幅度更高。意义：我们的研究结果表明实验结果与人类癫痫之间存在明显的联系。快速波纹与 HYP 的关联表明，不同锥体细胞簇的异相放电特别有助于这些癫痫发作的产生，而不是 LW 发作。在癫痫发作期间和癫痫发作之前，快速纹波分析可能有助于分类。
Objective: The distinction of hypersynchronous (HYP) and low-voltage fast (LVF) onset seizures in mesial temporal lobe epilepsy (MTLE) is well established, but classifying individual seizures and patients is often challenging. Experimental work indicates a strong association of HYP with fast ripples (250-500 Hz) and of LW with ripples (80-250 Hz). We aimed to investigate whether analysis of high-frequency oscillations can be useful for characterizing the process of seizure generation in human MTLE patients.Methods: We retrospectively compared 19 HYP and 14 LW onset clinical seizures from ten and six consecutive MTLE patients with a predominance of the respective pattern. Five-second intervals of stereotactic EEGs from the seizure onset zone were selected, each representing the onset of HYP and LW, the corresponding pre-ictal periods and, after the large spikes of HYP onsets, the LW-like pattern that frequently followed.Results: Pre-ictal fast ripple density and rate were higher for HYP than for LW seizures (p < .05). This association was also found for initial ictal segments (p < .001). Furthermore, fast ripple density and rate were higher during the LVF-like pattern after HYP spikes than during LVF without preceding HYP (p < .01). Ripple density and rate in contrast did not differ significantly (p > .05). Fast ripple (p < .01) and ripple (p < .001) amplitude was higher during the LW-like pattern after HYP spikes when compared to LW without preceding HYP.Significance: Our findings indicate a clear connection between experimental findings and human epilepsy. The association of fast ripples with HYP suggests that out-of-phase firing of different pyramidal cell clusters contributes specifically to generation of these seizures, rather than to LW onsets. Both during and immediately before seizures, fast ripple analysis may facilitate classification.