Di Gennaro Giancarlo, Quarato Pier Paolo, Sebastiano Fabio, Esposito Vincenzo, Onorati Paolo, Mascia Addolorata, Romanelli Pantaleo, Grammaldo Liliana G, Falco Carolina, Scoppetta Ciriaco, Eusebi Fabrizio, Manfredi Mario, Cantore Giampaolo
Epilepsy Surgery Unit, Department of Neurosciences, IRCCS NEUROMED, via Atinense, 18, 86077 Pozzilli (IS), Italy.
Clin Neurophysiol. 2004 May;115(5):1212-9. doi: 10.1016/j.clinph.2003.12.008.
To assess the prognostic value of scalp electroencephalogram (EEG) after epilepsy surgery, we investigated whether postoperative EEG abnormalities (interictal epileptiform discharges, IED; interictal slow activity, ISA) were associated with seizure outcome and other patient characteristics after resective surgery in patients with temporal lobe epilepsy (TLE).
Sixty-two patients with medically refractory TLE who underwent surgery were studied. Patients were categorized according to etiology (mesiotemporal sclerosis vs. tumors/cortical dysplasias); extent of surgical resection (extensive vs. limited); and amount of preoperative IED on wake EEG (oligospikers, <1 IED/h, vs. spikers). Patients were also classified as seizure-free (SF) or having persistent seizures/auras (not-SF) during follow up visits 1 month and 1 year after surgery. Preoperative 60-min interictal EEGs were evaluated for IED and ISA, and compared to postoperative wake EEGs.
Seizures/auras persisted in 16/62 (25.8%) patients at 1 month and in 8/62 (12.9%) at 1 year follow up. ISA was not significantly related to outcome. Of 42 patients with EEG negative for IED at 1 month, 4 were not-SF; at 1 year, one of 44 such patients was not-SF. IED was significantly associated with seizure/aura persistence in patients categorized as mesiotemporal sclerosis and with extensive surgery. Oligospikers and spikers on preoperative EEG showed no differences in the postoperative seizure outcome, excellent in both cases; moreover, the presence of postoperative IEDs indicated auras/seizures persistence apart from the preoperative EEG spike frequency.
Our study showed that the presence of IED of postoperatve EEG strongly indicates seizure/aura persistence. Therefore, serial EEGs should be included in postoperative follow up schedules as a crucial tool in evaluating seizure outcome.
为评估癫痫手术后头皮脑电图（EEG）的预后价值，我们调查了颞叶癫痫（TLE）患者接受切除性手术后，术后EEG异常（发作间期癫痫样放电，IED；发作间期慢波活动，ISA）是否与癫痫发作结局及其他患者特征相关。
对62例接受手术治疗的药物难治性TLE患者进行研究。根据病因（内侧颞叶硬化与肿瘤/皮质发育异常）、手术切除范围（广泛与有限）以及清醒EEG上术前IED的数量（少棘波，<1次IED/小时，与棘波）对患者进行分类。患者还被分为术后1个月和1年随访期间无癫痫发作（SF）或有持续性癫痫发作/先兆（非SF）。对术前60分钟的发作间期EEG进行IED和ISA评估，并与术后清醒EEG进行比较。
1个月时，16/62（25.8%）的患者癫痫发作/先兆持续存在，1年随访时为8/62（12.9%）。ISA与结局无显著相关性。1个月时EEG IED阴性的42例患者中，4例为非SF；1年时，44例此类患者中有1例为非SF。IED与内侧颞叶硬化分类且接受广泛手术的患者的癫痫发作/先兆持续存在显著相关。术前EEG上的少棘波和棘波在术后癫痫发作结局方面无差异，两种情况均良好；此外，术后IED的存在表明除术前EEG棘波频率外，先兆/癫痫发作持续存在。
我们的研究表明，术后EEG中IED的存在强烈提示癫痫发作/先兆持续存在。因此，应将系列EEG纳入术后随访计划，作为评估癫痫发作结局的关键工具。
