Stereo-EEG ictal/interictal patterns and underlying pathologies
Stereo-EEG ictal/interictal patterns and underlying pathologies
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DOI：
10.1016/j.seizure.2019.10.001
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发表时间：
2019-11-01
影响因子：
3
通讯作者：
Tassi, Laura
中科院分区：
文献类型：
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作者：
Di Giacomo, Roberta;Uribe-San-Martin, Reinaldo;Tassi, Laura
目的：确定一组耐药局灶性癫痫患者不同病理相关的立体脑电图（SEEG）初、间期模式。方法：回顾性分析102例多小回畸形（PMG）、脑室周围结节性异位（PNH）、局灶性皮质发育不良（FCD） I型、IIa型、IIb型和海马硬化症（HS）所致癫痫的临床资料。我们回顾了癫痫发作区（SEEG- soz）的发作期和间歇期的脑电图记录，并定义了病变区和刺激区。结果：发现了5种SEEG-SOZ模式：在低压快速活动和PMG之间，在重复快速尖峰爆发和FCD型Ha之间发现了显著的关联。快速活动与PNH、节律性剧烈活动与FCD型、重复性快速尖峰爆发与FCD型lib、缓慢爆发与HS之间存在一定的趋势。在102例患者中，62例患者进行了SEEG-SOZ的完全手术切除，12例患者进行了部分切除以保留雄辩区。在18例患者（15例PNH）中，SEEG-SOZ热凝固。58%的手术治疗患者和72%的热凝治疗患者实现了癫痫发作自由（平均+/- SD随访5.9 +/- 2.3年）。84%的PMG、FCD I、Ha和Ilb患者术后癫痫发作自由，表现为特征性的SEEG-SOZ模式。除FCD II型外，间期活动不足以确定SEEG-SOZ边界。结论：该研究表明，特定的组织病理学与特定的神经生理模式相关，反映了局灶性癫痫的病变特异性发作模式。
Purpose: To define Stereo-EEG (SEEG) ictal and interictal patterns associated with different pathologies in a cohort of patients with drug-resistant focal epilepsy.Methods: We retrospectively analyzed findings from 102 patient with epilepsy due to Polymicrogyria (PMG), Periventricular Nodular Heterotopia (PNH), Focal Cortical Dysplasia (FCD) type I, IIa, IIb and Hippocampal Sclerosis (HS). Ictal and interictal SEEG recordings were reviewed to describe Seizure Onset Zone (SEEG-SOZ) patterns and to define the Lesional and Irritative Zones.Results: Five SEEG-SOZ patterns were identified: significant associations were found between low-voltage fast activity and PMG and between repetitive fast spikes bursts and FCD type Ha. A trend was found between fast activity and PNH, rhythmic sharp activity and FCD type I, repetitive fast spikes bursts and FCD type lib, slow burst and HS. In 62 of the 102 patients, a complete surgical resection of the SEEG-SOZ was performed, and in 12 patients a partial resection was carried out to preserve eloquent areas. In 18 patients (15 with PNH) the SEEG-SOZ was thermo-coagulated. Seizure freedom was achieved in 58% of surgically treated patients and in 72% of those treated with thermocoagulation (mean +/- SD follow-up 5.9 +/- 2.3 years). Seizure freedom after surgery was achieved in 84% of the patients with PMG, FCD I, Ha and Ilb presenting with characteristic SEEG-SOZ patterns. With the exception of FCD type II, interictal activity was not sufficient to identify SEEG-SOZ boundaries. Conclusion: The study demonstrates that specific histopathologies correlate with particular neurophysiological patterns, reflecting lesion-specific seizure patterns in focal epilepsies.