Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery? Clinical article
Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery? Clinical article
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DOI：
10.3171/2011.1.peds10348
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发表时间：
2011-04-01
影响因子：
1.9
通讯作者：
Weiner, Howard L.
中科院分区：
文献类型：
--
作者：
Carlson, Chad;Teutonico, Federica;Weiner, Howard L.
物体。许多癫痫和结节性硬化症(TSC)的儿童在磁共振成像上有多个结节，而视频脑电(EEG)的定位/定侧较差。考虑到频繁发作和多种抗癫痫药物的长期风险，以及在多灶性病变患者中识别局灶性致痫区域的成功率提高，作者使用双侧颅内脑电对非定侧非侵入性术前评估的患者的致痫区域进行定侧。从1998年1月1日到2008年6月30日的一项回顾分析，确定了62名患有TSC的儿童，他们在外科会议上发表了论文。在研究期间接受诊断或治疗的52名患者中，20名接受了双侧颅内脑电检查。对其术前检查结果、颅内脑电图表现、手术治疗及预后进行回顾。20名患者中有14名患者的脑电结果与可切除的致痫区域一致。一名患者正在等待进一步的切除。5名患者的发现与不能切除的致痫区域一致，其中1名患者接受了膝盖骨切开术。7例患者的结果为Engel I级，I级为II级，3例为匹配级，3例为IV级(平均随访25个月)。双侧颅内EEG可以确定TSC中不可定侧癫痫的潜在可切除灶。虽然20名患者中有6名没有接受切除(1名患者正在等待未来的切除)，但8名患者的癫痫发作(Engel I级或II级)有显著改善。根据作者的经验，这种侵入性监测为识别发作区提供了一种安全的方法。(DOI：10.3171/2011.1.PEDS10348)
Object. Many children with epilepsy and tuberous sclerosis complex (TSC) have multiple tubers on MR imaging and poorly localized/lateralized video electroencephalography (EEG) findings. Given the long-term risks associated with frequent seizures and multiple antiepileptic drugs, along with improved success in identifying focal epileptogenic zones in patients with multifocal lesions, the authors used bilateral intracranial EEG to lateralize the epileptogenic zone in patients with nonlateralizable noninvasive preoperative evaluations.Methods. A retrospective analysis from January 1, 1998, to June 30,2008, identified 62 children with TSC who were presented at a surgical conference. Of the 52 patients undergoing diagnostic or therapeutic procedures during the study period, 20 underwent bilateral intracranial EEG. The presurgical testing results, intracranial EEG findings, surgical interventions, and outcomes were reviewed.Results. Fourteen of 20 patients had intracranial EEG findings consistent with a resectable epileptogenic zone. One patient is awaiting further resection. Five patients had findings consistent with a nonresectable epileptogenic zone, and 1 of these patients underwent a callosotomy. Seven patients had Engel Class I outcomes, I was Class II. 3 were Class fit, and 3 were Class IV (mean follow-up 25 months).Conclusions. Bilateral intracranial EEG can identify potential resectable seizure foci in nonlateralizable epilepsy in TSC. Although 6 of 20 patients did not undergo resection (1 patient is pending future resection), significant improvements in seizures (Engel Class I or II) were noted in 8 patients. In the authors' experience, this invasive monitoring provided a safe method for identifying the ictal onset zone. (DOI: 10.3171/2011.1.PEDS10348)