Gupta Ajay, Chirla Adina, Wyllie Elaine, Lachhwani Deepak K, Kotagal Prakash, Bingaman William E
Epilepsy Center, Neurological Institute, Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Pediatr Neurol. 2007 Jul;37(1):8-15. doi: 10.1016/j.pediatrneurol.2007.03.004.
Generalized abnormalities on scalp electroencephalograms (EEG) are not uncommon in children with partial epilepsy in whom a dominant focus of interictal and ictal abnormalities concordant to the brain lesion usually clarifies surgical candidacy. Children with exclusively generalized or multiregional EEG abnormalities and mental retardation are usually not considered surgical candidates, even when brain lesions are seen on imaging. Of 176 pediatric epilepsy surgeries at our center, we describe 10 children with exclusively generalized and multiregional interictal and ictal EEG abnormalities who had resection of a focal lesion seen on brain MRI. Surgical decisions were strengthened by clinical data. Surgery was offered as a last resort because of catastrophic epilepsy and treatment failures. At 26 months' mean postoperative follow-up, eight had no seizures, and two had infrequent seizures. Six months after surgery, generalized electroencephalographic abnormalities had resolved in all. We conclude that generalized and multiregional EEG abnormalities in the absence of dominant focus may not preclude epilepsy surgery in children with a congenital or acquired lesion seen on MRI. Generalized EEG abnormalities are likely secondary phenomena that resolve after surgery. Maladaptive neural plasticity and secondary epileptogenesis are potential mechanisms that mask an epileptogenic lesion with generalized EEG abnormalities.
头皮脑电图（EEG）的广泛性异常在部分性癫痫患儿中并不罕见，在这些患儿中，发作间期和发作期异常的主要病灶与脑损伤一致，这通常能明确手术适应症。仅有广泛性或多区域脑电图异常及智力发育迟缓的儿童通常不被视为手术候选者，即便影像学检查发现有脑损伤。在我们中心进行的176例小儿癫痫手术中，我们描述了10例仅有广泛性和多区域发作间期及发作期脑电图异常的患儿，他们接受了脑部MRI检查发现的局灶性病变切除术。临床资料强化了手术决策。由于严重癫痫和治疗失败，手术被作为最后手段实施。术后平均随访26个月时，8例无癫痫发作，2例有偶发癫痫发作。术后6个月时，所有人的广泛性脑电图异常均已消失。我们得出结论，在MRI上发现有先天性或后天性病变的儿童中，无主要病灶的广泛性和多区域脑电图异常可能并不排除癫痫手术。广泛性脑电图异常可能是术后会消失的继发现象。适应性不良的神经可塑性和继发性癫痫发生是用广泛性脑电图异常掩盖致痫病灶的潜在机制。
