Postictal clinical and EEG activity following intracranially recorded bilateral tonic-clonic seizures.
Postictal clinical and EEG activity following intracranially recorded bilateral tonic-clonic seizures.
复制标题
颅内记录的双侧强直阵挛发作后的发作后临床和脑电图活动。
DOI：
10.1111/epi.16274
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发表时间：
2019
期刊：
影响因子：
5.6
通讯作者：
Schevon,CatherineA
中科院分区：
文献类型：
--
作者：
Bateman,LisaM;Schevon,CatherineA
我们很高兴有机会回复 McGonigal 等人的来信，该信对我们在颅内记录的发作后衰减 (IPA) (1) 过程中观察到的伽玛活动提出了替代解释。在我们的论文中，由于颅内植入物典型的有限且通常是单侧的空间覆盖，我们避免在 IPA 和发作后广义脑电图抑制 (PGES) 之间建立直观的联系。然而，这封信的作者在他们的相关研究中已经这样做了（2）。我们同意有必要对发作后脑电图衰减进行进一步研究，但该主题非常复杂，需要在综合性同行评审出版物中予以解决。在我们的手稿中，我们讨论了几条证据，这些证据使我们得出这样的结论：IPA 相关的伽马活性是大脑起源的。我们在这里重申其中的一些内容。首先，发作后伽马活动的模式通常与肌电图活动不一致，肌电图活动的强度会在几秒钟后减弱。这可以从这封信的图 D 中看出。其次，与临床症状学没有相关性。它很可能表现为松弛和僵硬不动，并且似乎不受身体抽搐或其他短暂运动的调节。事实上，在我们论文 (1) 的图 2 中，可以看到伽玛活动仅在发作期双侧阵挛性抽搐停止后才出现。第三，我们观察到具有叠加伽马活动的 IPA 与脑电图呈尖峰减慢的时期交替的情况，在此期间伽马活动消失并且可以看到患者的自愿运动。
We appreciate the opportunity to respond to the letter from McGonigal, et al., which proposes alternative explanations for our observations of gamma activity during intracranially recorded postictal attenuation (IPA)(1). In our paper, we had avoided making the intuitive connection between IPA and postictal generalized EEG suppression (PGES) due to the limited, often unilateral spatial coverage that is typical of intracranial implants. However, the authors of the letter had done so in their related study (2).We agree that further study of postictal EEG attenuation is warranted, however the topic is sufficiently complex that it needs to be addressed in a comprehensive peer-reviewed publication. In our manuscript, we discussed several lines of evidence that led us to the conclusion that the IPA-associated gamma activity is of cerebral origin. We reiterate a few of these here. First, the pattern of postictal gamma activity is often inconsistent with EMG activity, which would diminish in power after a few seconds. This can be seen in the letter’s Figure panel D. Second, there was no correlation with clinical semiology. It was as likely to appear with flaccid as with rigid immobility, and did not appear to be modulated by body jerks or other transient movements. In fact, in Figure 2 of our paper (1), gamma activity can be seen to emerge only after ictal bilateral clonic jerking ceases. Third, we observed cases in which IPA with superimposed gamma activity alternates with periods of EEG slowing with spikes, during which the gamma activity disappears and voluntary patient movements can be seen.
影响因子：
8
作者：
Holden Kr;E. Mellits;J. Freeman
通讯作者：
J. Freeman
影响因子：
11.2
作者：
BERGMAN, I;PAINTER, MJ;DAVID, R
通讯作者：
DAVID, R
影响因子：
158.5
作者：
Painter, MJ;Scher, MS;Alvin, J
通讯作者：
Alvin, J