From the Epilepsy Program, Department of Clinical Neurosciences, University of Western Ontario, University Hospital, London, Ontario, Canada.
J Clin Neurophysiol. 2010 Oct;27(5):309-11. doi: 10.1097/WNP.0b013e3181f38693.
To assess the pathophysiological complexity of cortical dysplasia-related intractable focal epilepsy among surgical candidates, using our data-based EEG classification system, we reviewed preresection scalp awake and sleep EEGs (median, 8) in 46 consecutive patients whose resected pathology disclosed cortical dysplasia. Epileptiform phenomena occurred on at least one EEG in 42 (91%) patients. Twenty-three (50%) of the 46 patients displayed at least one type of independently occurring abnormality (spikes, excess delta, or theta) in each hemisphere. Nineteen of these 23 (83%), thus 41% of all 46 patients, showed independently occurring epileptiform abnormalities (spikes) in each hemisphere, i.e., the multiple independent spike foci phenomenon. In an additional 13 of the 46 (28%) patients, spike foci involving more than one lobe appeared within a single hemisphere. Thus, spike foci involving more than one lobe appeared in 32 of the 46 (70%) patients. Generalized bilaterally synchronous epileptiform features (spike waves, slow spike waves, or fast rhythmic waves) appeared in 10 (22%) of the 46 patients. Two findings suggest more widespread dysfunction among extratemporal patients than temporal patients: (1) a significantly higher number of lobes containing focal interictal epileptiform activity in extra temporal patients (mean = 3.14) than among temporal patients (mean = 2.14) (P = 0.02), (2) a higher percentage of bisynchronous epileptiform abnormalities: 8 of 23 (35%) versus 2 of 23 (9%). Among 34 patients with a Principal Spike Lobe (more active spiking over more EEGs), those of 32 (94%) arose from the ultimately resected lobe. Of the 30 patients with scalp-recorded seizures, relationship between seizure origin and ultimately resected lobe were same lobe (16 patients), same and adjacent lobes (12), adjacent lobe only (1), and distant lobe (1). Thus, despite the multifocality of several EEG features, Principal Spike Lobe and scalp-recorded seizure origin correlate well with epileptogenesis.
为了评估手术候选者中与皮质发育不良相关的难治性局灶性癫痫的病理生理复杂性，我们使用基于数据的 EEG 分类系统，回顾了 46 例连续患者的术前头皮清醒和睡眠 EEG（中位数为 8 个），这些患者的切除病理显示皮质发育不良。42 例（91%）患者的至少一个 EEG 中出现癫痫样现象。46 例患者中有 23 例（50%）显示每侧半球至少有一种独立发生的异常（棘波、过多的 delta 波或 theta 波）。其中 19 例（83%），即 46 例患者中的 41%，每侧半球均出现独立的癫痫样异常（棘波），即多个独立棘波灶现象。在另外 13 例（28%）患者中，单个半球内出现涉及多个脑叶的棘波灶。因此，46 例患者中有 32 例（70%）出现多个脑叶的棘波灶。46 例患者中有 10 例（22%）出现双侧同步性癫痫样特征（棘波、慢棘波或快节律波）。两个发现表明颞叶外患者比颞叶患者有更广泛的功能障碍：（1）颞叶外患者（mean = 3.14）含有局灶性发作间期癫痫样活动的脑叶数量明显多于颞叶患者（mean = 2.14）（P = 0.02），（2）双同步性癫痫样异常的比例较高：23 例中有 8 例（35%）与 23 例中有 2 例（9%）相比。在 34 例主要棘波叶（更多棘波出现在更多 EEG 上）的患者中，32 例（94%）起源于最终切除的叶。在 30 例有头皮记录的发作的患者中，发作起源与最终切除的叶的关系是同侧叶（16 例）、同侧和相邻叶（12 例）、相邻叶（1 例）和远隔叶（1 例）。因此，尽管存在多个 EEG 特征的多灶性，但主要棘波叶和头皮记录的发作起源与癫痫发生密切相关。
