Kanazawa Kyoko, Matsumoto Riki, Kinoshita Masako, Ikeda Akio
Department of Neurology, Kyoto University, Sakyo-ku, Kyoto-shi, Kyoto, Japan.
Brain Nerve. 2011 Apr;63(4):355-64.
Seizure onset zone (SOZ) is currently defined by ictal epileptiform discharges, which are most commonly recorded as regional low-voltage fast waves or repetitive spikes. Interictal epileptiform discharges, on the other hand, are not specific enough for SOZ as they are recorded at zones other than the SOZ; they are also recorded from areas that do not generate the ictal pattern and from areas to which ictal discharges propagate. Besides spikes and sharp waves, a novel index of human epileptogenicity has been investigated in association with wide-band electroencephalography (EEG) analysis. We primarily noted the following during clinical neurophysiological analysis for clinical epilepsy. (1) Recent development of digital EEG technology enabled us to record wide-band EEG in a clinical setting. Thus, high frequency (>200 Hz) and low frequency (<1 Hz) components can be reliably recorded using subdural electrodes. Direct current shift, slow shift, ripple, and fast ripple can be well delineated, and they will be potentially useful in the diagnosis and management of epileptic patients. (2) Fiber tractography (morphological parameter) and cortico-cortical-evoked potentials with single cortical stimulation (electrophysiological parameter) elucidated cortico-cortical connections in human brain. The data thus obtained can help us understand the mechanism of seizure propagation and normal cortical functional connectivity. (3) Non-invasive simultaneous recording of EEG and functional magnetic resonance imaging (fMRI) provided information on the roles of deep brain structures associated with scalp-recorded epileptiform discharges. Interventional neurophysiology can shed light on the non-pharmacological treatment of epilepsy. In this report, we discuss these novel electrophysiological approaches to the diagnosis and treatment of clinical epilepsy.
癫痫发作起始区（SOZ）目前由发作期癫痫样放电定义，发作期癫痫样放电最常记录为局部低电压快波或重复性棘波。另一方面，发作间期癫痫样放电对SOZ的特异性不足，因为它们是在SOZ以外的区域记录到的；它们也可从不产生发作期模式的区域以及发作期放电传播至的区域记录到。除了棘波和尖波外，一种与宽带脑电图（EEG）分析相关的新型人类致痫性指标也已得到研究。在对临床癫痫进行临床神经生理学分析过程中，我们主要注意到以下几点。（1）数字EEG技术的最新发展使我们能够在临床环境中记录宽带EEG。因此，使用硬膜下电极可以可靠地记录高频（>200Hz）和低频（<1Hz）成分。直流偏移、慢偏移、涟波和快涟波能够得到很好的描绘，它们在癫痫患者的诊断和管理中可能会很有用。（2）纤维束成像（形态学参数）和单皮质刺激的皮质 - 皮质诱发电位（电生理参数）阐明了人脑内的皮质 - 皮质连接。由此获得的数据有助于我们理解癫痫发作传播机制和正常皮质功能连接。（3）EEG与功能磁共振成像（fMRI）的非侵入性同步记录提供了与头皮记录的癫痫样放电相关的深部脑结构作用的信息。介入神经生理学可以为癫痫的非药物治疗提供线索。在本报告中，我们讨论这些用于临床癫痫诊断和治疗的新型电生理方法。
