Hou Xiao-bing, Zhou Quan, Wang Guo-fu, Xie Jian
Department of Neurology, First People's Hospital of Foshan, Foshan 528000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 Oct;30(10):2363-5.
To investigate spike wave reduction in electrocorticography (EcoG) monitoring for evaluating the outcomes of epilepsy surgery.
The epileptogenesis lesions in the target cortex was localized accurately using an EcoG monitoring system in 20 surgical patients with intractable EP. The spike numbers within 60 s were recorded before and after surgical resection of the epileptogenic focus. In cases where the spike number within 60 s was reduced by over 80% after the resection, the surgery was terminated, otherwise extended lesion resection, corpus callosotomy or multiple subpial transection (MST) was carried out with ECoG monitoring, and the spike number within 60 s was recorded. Antiepileptic drugs were routinely prescribed after the operations.
Twelve patients exhibited a spike wave reduction by over 80% after resection or extended resection of the lesions, including 4 with cavernomas in the nonfunctional area, who showed a spike wave reduction by over 80% after extended resection of the cortex around the tumor. The reduction was still less than 80% in 4 patients with hippocampal sclerosis and 3 with neurogliocytoma in the functional area after the operations. According to the Engel assessments, 13 cases were in level I, 3 cases in level II, 1 in level III, and 3 in level IV. Seventeen patients responded favorably to the treatment, with a total effective rate of 85%.
For extra-temporal lobe epilepsy, a postoperative spike wave reduction beyond 80% indicate favorable outcome of the surgery, otherwise poor prognosis is expected. But in cases of temporal lobe epilepsy, no direct association is found between spike wave reduction and the prognosis of the patients.
探讨皮质脑电图（EcoG）监测中棘波减少情况以评估癫痫手术效果。
使用EcoG监测系统对20例难治性癫痫手术患者的目标皮质癫痫病灶进行精确定位。记录癫痫病灶切除术前、后60秒内的棘波数量。若切除术后60秒内棘波数量减少超过80%，则终止手术；否则在EcoG监测下进行扩大病灶切除、胼胝体切开术或多处软膜下横切术（MST），并记录60秒内的棘波数量。术后常规给予抗癫痫药物。
12例患者在病灶切除或扩大切除后棘波减少超过80%，其中4例非功能区海绵状血管瘤患者，在肿瘤周围皮质扩大切除后棘波减少超过80%。4例海马硬化患者和3例功能区神经胶质细胞瘤患者术后棘波减少仍小于80%。根据Engel评估，Ⅰ级13例，Ⅱ级3例，Ⅲ级1例，Ⅳ级3例。17例患者治疗效果良好，总有效率为85%。
对于颞叶外癫痫，术后棘波减少超过80%提示手术效果良好，否则预后较差。但对于颞叶癫痫，未发现棘波减少与患者预后之间存在直接关联。
