Usui Naotaka, Mihara Tadahiro, Baba Koichi, Matsuda Kazumi, Tottori Takayasu, Umeoka Shuichi, Nakamura Fumihiro, Terada Kiyohito, Usui Keiko, Inoue Yushi
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama, Shizuoka, Japan.
Epilepsy Res. 2008 Jan;78(1):82-91. doi: 10.1016/j.eplepsyres.2007.10.009.
Intracranial EEG in patients with lesional lateral temporal lobe epilepsy is rarely reported. Therefore, the number of patients with seizures arising independently from ipsilateral mesial structures or contralateral hemisphere has not been clarified. We analyzed the intracranial EEG of cases with localized lesion in the lateral temporal cortex.
We studied 15 patients who satisfied the following criteria: (1) MRI depicted a lesion less than 4cm in diameter located lateral to the collateral sulcus and at least 3cm posterior to the temporal pole; (2) intracranial EEG with electrodes placed on bilateral temporal lobes captured at least one complex partial seizure; and (3) postoperative follow-up period of 2 years or longer. The mean age of seizure onset was 16.6 years (range, 11-25) and that at surgery was 26.7 years (range, 16-36).
A total of 147 complex partial seizures, 51 simple partial seizures, 16 secondarily generalized seizures, and over 80 subclinical seizures were recorded. On the lesional side, many clinical seizures were recorded from the lateral cortex. Independent of the lateral temporal onset seizures, ictal discharges originating from the mesial temporal structures were recorded in 7 of 15 patients (47%). Moreover, onset of ictal discharges from the contralateral temporal lobe was recorded in 7 of 15 patients (47%). Interictal spikes from ipsilateral mesial structures were recorded in all patients. The presence of ipsilateral mesial onset seizures was not associated with hippocampal neuron losses.
Intracranial EEG analysis revealed that approximately one-half of the patients with structural lesions in the lateral cortex showed independent epileptogenic areas in ipsilateral mesial structures. Although ictal discharges originating from the contralateral temporal lobe were recorded in a half of these patients, this finding does not constitute a contraindication of resective surgery. Interictal spike is not an indicator of whether mesial structures should be resected.
关于患有病变性外侧颞叶癫痫患者的颅内脑电图研究报道较少。因此，源自同侧内侧结构或对侧半球的独立发作患者数量尚不明确。我们分析了外侧颞叶皮质局限性病变病例的颅内脑电图。
我们研究了15例符合以下标准的患者：（1）MRI显示直径小于4cm的病变位于侧副沟外侧且距颞极至少3cm后方；（2）双侧颞叶放置电极的颅内脑电图记录到至少一次复杂部分性发作；（3）术后随访期为2年或更长时间。癫痫发作的平均起始年龄为16.6岁（范围11 - 25岁），手术时的平均年龄为26.7岁（范围16 - 36岁）。
共记录到147次复杂部分性发作、51次简单部分性发作、16次继发性全身性发作以及80多次亚临床发作。在病变侧，外侧皮质记录到许多临床发作。在15例患者中的7例（47%）记录到独立于外侧颞叶起始发作，源自内侧颞叶结构的发作期放电。此外，15例患者中的7例（47%）记录到对侧颞叶发作期放电起始。所有患者均记录到同侧内侧结构的发作间期棘波。同侧内侧起始发作的存在与海马神经元丢失无关。
颅内脑电图分析显示，外侧皮质有结构性病变的患者中约一半在同侧内侧结构显示独立的致痫区。尽管在这些患者中有一半记录到源自对侧颞叶的发作期放电，但这一发现并不构成切除性手术的禁忌证。发作间期棘波并非内侧结构是否应切除的指标。
