Intracranial EEG analysis in tumor-related epilepsy: Evidence of distant epileptic abnormalities
Intracranial EEG analysis in tumor-related epilepsy: Evidence of distant epileptic abnormalities
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DOI：
10.1016/j.clinph.2015.06.028
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发表时间：
2016-01-01
影响因子：
4.7
通讯作者：
Shah, A. K.
中科院分区：
文献类型：
--
作者：
Mittal, S.;Barkmeier, D.;Shah, A. K.
目的：在肿瘤相关性癫痫（TRE）患者中，手术传统上侧重于肿瘤切除；但识别和切除相关的致痫区可能会改善癫痫发作的预后。在此，我们研究肿瘤与癫痫发作起始区和早期传播区（SOSz）的空间关系。我们还对TRE患者和非病灶性癫痫患者的发作间期癫痫样活动进行定量分析，以便更好地理解癫痫发生的电生理基础。
方法：25例患者（11例TRE患者和14例非病灶性癫痫患者）使用颅内电极进行分期手术。在磁共振成像（MRI）上勾勒出肿瘤轮廓，并将图像与植入电极后的计算机断层扫描（CT）图像进行配准。对于每个电极，测量其到最近肿瘤边缘的距离。根据电极距肿瘤的距离以及是否参与癫痫发作对电极进行分类。对发作间期棘波的频率、幅度、功率、持续时间和斜率进行定量脑电图分析。
结果：在11例患者中的10例，至少部分SOSz位于距肿瘤边缘1.5厘米以外。在发作间期，SOSz的棘波频率和功率较高，而肿瘤附近的棘波较小且较不尖锐。有趣的是，肿瘤周围电极的棘波频率最高且最尖锐，表明癫痫同步性程度最高。完全切除SOSz可使癫痫发作预后良好。
结论：癫痫发作起始和早期传播常涉及远离肿瘤的脑区。
意义：对TRE采用癫痫手术方法可能会提供更好的癫痫发作预后，对颅内脑电图的研究可能会深入了解TRE的病理生理学。（C）2015国际临床神经生理学联合会。由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Objective: In patients with tumor-related epilepsy (TRE), surgery traditionally focuses on tumor resection; but identification and removal of associated epileptogenic zone may improve seizure outcome. Here, we study spatial relationship of tumor and seizure onset and early spread zone (SOSz). We also perform quantitative analysis of interictal epileptiform activities in patients with both TRE and non-lesional epilepsy in order to better understand the electrophysiological basis of epileptogenesis.Methods: Twenty-five patients (11 with TRE and 14 with non-lesional epilepsy) underwent staged surgery using intracranial electrodes. Tumors were outlined on MRI and images were coregistered with post-implantation CT images. For each electrode, distance to the nearest tumor margin was measured. Electrodes were categorized based on distance from tumor and involvement in seizure. Quantitative EEG analysis studying frequency, amplitude, power, duration and slope of interictal spikes was performed.Results: At least part of the SOSz was located beyond 1.5 cm from the tumor margin in 10/11 patients. Interictally, spike frequency and power were higher in the SOSz and spikes near tumor were smaller and less sharp. Interestingly, peritumoral electrodes had the highest spike frequencies and sharpest spikes, indicating greatest degree of epileptic synchrony. A complete resection of the SOSz resulted in excellent seizure outcome.Conclusions: Seizure onset and early spread often involves brain areas distant from the tumor.Significance: Utilization of epilepsy surgery approach for TRE may provide better seizure outcome and study of the intracranial EEG may provide insight into pathophysiology of TRE. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.