Bernasconi A, Martinez V, Rosa-Neto P, D'Agostino D, Bernasconi N, Berkovic S, MacKay M, Harvey A S, Palmini A, da Costa J C, Paglioli E, Kim H I, Connolly M, Olivier A, Dubeau F, Andermann E, Guerrini R, Whisler W, de Toledo-Morrell L, Morrell F, Andermann F
Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada.
Epilepsia. 2001 Sep;42(9):1124-9. doi: 10.1046/j.1528-1157.2001.39900.x.
To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder.
We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI).
All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved.
Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.
分析患有皮质下带状异位或双皮质综合征（一种弥漫性神经元迁移障碍）的顽固性癫痫患者的手术治疗结果。
我们研究了8例患有双皮质综合征和顽固性癫痫的患者（5名女性）。所有患者均接受了全面的术前评估，包括长时间视频脑电图记录和磁共振成像（MRI）。
所有患者均有部分性发作，其中6例继发全面性发作。所有患者神经系统检查均正常。3例智力正常，5例轻度智力发育迟缓。6例患者进行了有创脑电图记录，其中3例使用硬膜下网格电极，3例使用立体定向植入深部电极（SEEG）。尽管脑电图记录显示大多数患者存在多叶癫痫异常，但所有患者均记录到区域性或局灶性癫痫发作起始。MRI显示双侧皮质下带状异位，3例厚度不对称。1例患者在左额叶发现额外的皮质增厚区域。手术方式包括2例患者进行多处软膜下横切术，1例进行额叶病灶切除术，5例进行颞叶切除术加杏仁核海马切除术，1例额外进行了胼胝体前部切开术。5例患者无明显改善，2例有一定改善，1例有显著改善。
我们的结果不支持对双皮质综合征患者进行局灶性手术切除致痫组织，即使存在相对局限性的致痫区域。
