伴有内侧颞叶癫痫的罗兰区良性癫痫样放电：脑磁图、头皮及颅内脑电图特征
Benign epileptiform discharges in Rolandic region with mesial temporal lobe epilepsy: MEG, scalp and intracranial EEG features.
作者信息
RamachandranNair R, Ochi A, Benifla M, Rutka J T, Snead O C, Otsubo H
机构信息
Division of Neurology, Department of Paediatrics, Hospital for sick Children, Toronto, Ontario, Canada.
出版信息
Acta Neurol Scand. 2007 Jul;116(1):59-64. doi: 10.1111/j.1600-0404.2006.00759.x.
AIM OF THE STUDY
To report benign epileptiform discharges (BEDs) in the Rolandic region, coexisting in a pediatric patient with intractable localization-related epilepsy, secondary to hippocampal sclerosis.
METHODS
We describe the clinical features, MRI, scalp video EEG, magnetoencephalography (MEG) and intracranial video EEG findings, and surgical outcome in a 9-year-old boy with BEDs and intractable complex partial seizures.
RESULTS
MRI showed left hippocampal sclerosis. Scalp video EEG interictally demonstrated left temporal spike and sharply contoured slow waves, and right fronto-centro-temporal spike and waves. Ictal scalp video EEG showed left temporal rhythmic sharp waves after the clinical onset of epigastric aura, followed by staring. MEG showed interictal dipoles in the bilateral Rolandic regions with a uniform orientation and right hemispheric predominance. Intracranial video EEG, with bilateral mesial temporal depth and fronto-temporo-parietal strip electrodes, interictally showed polyspikes and slow waves with superimposed low-amplitude fast waves in the left mesial and posterior lateral temporal regions, and spike and waves in the bilateral fronto-parietal regions. Ictal onset was marked by low-amplitude fast waves in the left mesial and posterior lateral temporal regions. He underwent left anterior temporal lobectomy with hippocampectomy. Pathology was hippocampal sclerosis. Predominant right fronto-centro-temporal spike and waves and MEG right Rolandic dipoles persisted after surgery. He was seizure-free 14 months after surgery.
CONCLUSION
This is the first report on MEG and intracranial video EEG features of BEDs in the Rolandic region, coexisting with hippocampal sclerosis. Persistence of contralateral benign MEG Rolandic dipoles after surgery indicates that BEDs are coincidental in mesial temporal lobe epilepsy. MEG identified Rolandic dipoles, although was unable to localize the deep and focal epileptogenic dipoles from the hippocampal sclerosis.
研究目的
报告罗兰区良性癫痫样放电（BEDs），其并存于一名继发于海马硬化的难治性局灶性癫痫患儿。
方法
我们描述了一名患有BEDs和难治性复杂部分性发作的9岁男孩的临床特征、MRI、头皮视频脑电图、脑磁图（MEG）和颅内视频脑电图结果以及手术结果。
结果
MRI显示左侧海马硬化。头皮视频脑电图发作间期显示左侧颞叶尖波和轮廓清晰的慢波，以及右侧额中央颞叶尖波和波。发作期头皮视频脑电图显示在腹部先兆临床发作后左侧颞叶有节律性锐波，随后出现凝视。MEG显示双侧罗兰区发作间期偶极子，方向一致且以右侧半球为主。颅内视频脑电图使用双侧内侧颞叶深部和额颞顶条状电极，发作间期显示左侧内侧和后外侧颞叶区域有多棘波和慢波，并叠加低幅快波，双侧额顶叶区域有尖波和波。发作起始以左侧内侧和后外侧颞叶区域的低幅快波为特征。他接受了左侧前颞叶切除术加海马切除术。病理检查为海马硬化。术后右侧额中央颞叶尖波和波以及MEG右侧罗兰区偶极子仍然存在。术后14个月他无癫痫发作。
结论
这是关于罗兰区BEDs与海马硬化并存的MEG和颅内视频脑电图特征的首次报告。术后对侧良性MEG罗兰区偶极子持续存在表明BEDs在内侧颞叶癫痫中是巧合。MEG识别出了罗兰区偶极子，尽管无法定位海马硬化深部和局灶性致痫偶极子。
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