Lee S K, Kim J Y, Hong K S, Nam H W, Park S H, Chung C K
Departments of Neurology and Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Epilepsia. 2000 Nov;41(11):1450-5. doi: 10.1111/j.1528-1157.2000.tb00121.x.
Localizable scalp EEGs, during ictal episodes, appear to be rare in neocortical epileptic syndromes. However, studies based on large numbers of patients are also rare. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic focuses.
We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded using a video-EEG monitoring system with electrodes placed according to the International 10-20 system, with additional anterior temporal electrodes. The ictal recordings were analyzed according to localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured.
The percentage of discrete or regional EEGs was 23% in frontal lobe epilepsy, 52% in lateral temporal lobe epilepsy, 70% in occipital lobe epilepsy, and 10% in parietal lobe epilepsy. In order of frequency, the localizable ictal rhythms were theta, beta, alpha, delta, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms was significantly shorter in frontal lobe epilepsy and parietal lobe epilepsy than in other epilepsies. Ictal beta activity was the most common rhythm in discrete-patterned EEGs. Structural lesions found on MRI did not significantly affect the localization of epileptogenic focuses in the patients. The type of seizure was not related to the degree of localization, with the exception of simple partial seizure.
Ictal surface EEG was clinically helpful in the localization of epileptogenic focuses in at least some neocortical epileptic syndromes.
在新皮质癫痫综合征的发作期，可定位的头皮脑电图似乎很少见。然而，基于大量患者的研究也很罕见。本研究旨在确定各种新皮质癫痫的特征模式，并评估其在癫痫灶定位中的临床实用性。
我们回顾性评估了86例随后接受侵入性研究和切除性手术患者的394份非侵入性发作期记录。使用视频脑电图监测系统记录发作期脑电图，电极根据国际10-20系统放置，并额外增加前颞电极。根据定位准确性和频率特征分析发作期记录。还测量了离散或区域发作期节律的持续时间。
额叶癫痫中离散或区域脑电图的比例为23%，颞叶外侧癫痫为52%，枕叶癫痫为70%，顶叶癫痫为10%。按频率排序，可定位的发作期节律为θ波、β波、α波、δ波和节律性棘慢波。额叶癫痫和顶叶癫痫中离散或区域发作期节律的持续时间明显短于其他癫痫。发作期β活动是离散型脑电图中最常见的节律。MRI上发现的结构性病变对患者癫痫灶的定位没有显著影响。除简单部分性发作外，发作类型与定位程度无关。
发作期头皮脑电图在至少某些新皮质癫痫综合征的癫痫灶定位中具有临床帮助。
