Galicia Elaine, Imai Katsumi, Mohamed Ismail S, Go Cristina, Fujimoto Ayataka, Ochi Ayako, Sakuta Ryoichi, Halliday William, Rutka James T, Chuang Sylvester H, Snead O Carter, Otsubo Hiroshi
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Brain Dev. 2009 Sep;31(8):569-76. doi: 10.1016/j.braindev.2008.08.011. Epub 2008 Oct 1.
Cortical dysplasia (CD) is intrinsically epileptogenic. We hypothesize that CDs clinically emerging in the early developing brain tend to extend into multifocal or larger epileptic networks to pronounce intractability in contrast to CDs which clinically emerge at a later age.
We evaluated the spatial and temporal profiles of ictal-onset EEG patterns in children with histopathologically confirmed CD. We designated Group A as children with changing ictal-onset EEG patterns over time, and Group B without change. We compared seizure profiles, consecutive scalp video-EEGs (VEEGs), MRI, MEG, and surgical outcomes.
We found 14 children consisting of 10 Group A patients (7 girls) and 4 Group B patients (all boys). Eight (80%) Group A patients had their seizure onset <5 years while all Group B patients had seizure onset >or=5 years (p<.05). Changes of ictal onset EEG pattern in Group A consisted of bilateral (4 patients), extending (2); extending and bilateral (2); and generalized (2). We saw MRI lesions (6) and single clustered MEG spike sources (MEGSSs) in (5). Six patients underwent surgery before 15 years of age, and 4 of them attained seizure freedom. All 4 Group B patients had MRI lesions and single clustered MEGSSs. Three patients underwent surgery after 15 years of age. All 4 patients attained seizure freedom.
Ictal-onset EEG patterns change over time in children with early seizure onset and intractable epilepsy caused by CD. Younger epileptic children with CD more frequently have multifocal epileptogenic foci or larger epileptogenic foci. Early resection of CD, guided by MRI, MEG, and intracranial video EEG, resulted in seizure freedom despite changes in ictal-onset EEG patterns.
皮质发育异常（CD）本质上具有致痫性。我们假设，与在发育后期临床出现的CD相比，在脑发育早期临床出现的CD往往会扩展到多灶性或更大的癫痫网络中，从而导致难治性癫痫。
我们评估了组织病理学确诊为CD的儿童发作期起始脑电图（EEG）模式的空间和时间特征。我们将A组定义为发作期起始EEG模式随时间变化的儿童，B组为无变化的儿童。我们比较了癫痫发作特征、连续头皮视频脑电图（VEEG）、磁共振成像（MRI）、脑磁图（MEG）和手术结果。
我们发现14名儿童，其中10名A组患者（7名女孩）和4名B组患者（均为男孩）。8名（80%）A组患者癫痫发作起始年龄<5岁，而所有B组患者癫痫发作起始年龄≥5岁（p<0.05）。A组发作期起始EEG模式的变化包括双侧（4例患者）、扩展（2例）、扩展并双侧（2例）和全身性（2例）。我们在6例患者中看到MRI病变，在5例患者中看到单个簇状脑磁图尖峰源（MEGSSs）。6例患者在15岁之前接受了手术，其中4例实现了无癫痫发作。所有4例B组患者均有MRI病变和单个簇状MEGSSs。3例患者在15岁之后接受了手术。所有4例患者均实现了无癫痫发作。
对于由CD引起的早期癫痫发作和难治性癫痫患儿，发作期起始EEG模式随时间变化。年龄较小的患有CD的癫痫患儿更常出现多灶性致痫灶或更大的致痫灶。在MRI、MEG和颅内视频脑电图的引导下，早期切除CD可实现无癫痫发作，尽管发作期起始EEG模式有所变化。
