Department of Child Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands.
Clin Neurophysiol. 2010 Jun;121(6):842-7. doi: 10.1016/j.clinph.2010.01.010. Epub 2010 Feb 11.
In the majority of patients with tuberous sclerosis complex (TSC) multifocal epileptiform activity is present interictally. Therefore, its value in identifying epilepsy surgery candidates has been doubted. We hypothesize that dominant interictal epileptiform foci are concordant with the ictal onset zone in TSC patients.
Consistency and dominance of focal interictal epileptiform activity was assessed in 19 patients with a clinical definite diagnosis of TSC. The ictal onset zone was identified. Concordance between interictal en ictal findings was analyzed. If concordance was found epilepsy surgery was proposed.
We found dominant, consistently present, focal interictal epileptiform activity in 14 of the 19 patients. Concordance between the dominant interictal focus and the ictal onset zone was found in 11 of the 14 patients (79%). In one patient the ictal onset zone could not be identified and discordance was present in two patients. Epilepsy surgery was performed in six patients rendering three of them seizure free, and one had a seizure reduction >90%. In these patients local concordance was found whereas regional concordance was found in the two patients who did not benefit from epilepsy surgery.
A dominant as well as a consistent interictal focus is concordant with the ictal onset zone in the majority of TSC patients.
Future studies of TSC patients addressing the value of interictal foci in the consideration of epilepsy surgery, in absence of clear ictal onset zone, are necessary.
在大多数结节性硬化症（TSC）患者中，存在多灶性癫痫样活动。因此，其在确定癫痫手术候选者中的价值受到了质疑。我们假设，显性局灶性发作间期癫痫样放电与 TSC 患者的发作起始区是一致的。
对 19 例临床确诊为 TSC 的患者进行局灶性发作间期癫痫样放电的一致性和优势性评估。确定发作起始区。分析发作间期和发作期发现的一致性。如果发现一致性，则提出癫痫手术。
我们发现 19 例患者中有 14 例存在优势、持续存在的局灶性发作间期癫痫样放电。在 14 例患者中有 11 例（79%）发现优势发作间期焦点与发作起始区一致。在 1 例患者中无法确定发作起始区，在 2 例患者中存在不一致性。对 6 例患者进行了癫痫手术，其中 3 例患者癫痫发作得到控制，1 例患者癫痫发作减少>90%。在这些患者中发现了局部一致性，而在未从癫痫手术中获益的 2 例患者中发现了区域性一致性。
在大多数 TSC 患者中，显性和一致性的发作间期焦点与发作起始区是一致的。
在没有明确的发作起始区的情况下，未来针对 TSC 患者的研究需要进一步探讨发作间期焦点在考虑癫痫手术中的价值。
