Carlson Chad, Teutonico Federica, Elliott Robert E, Moshel Yaron A, LaJoie Josiane, Miles Daniel, Devinsky Orrin, Weiner Howard L
Department of Neurology, New York University School of Medicine, New York, New York, USA.
J Neurosurg Pediatr. 2011 Apr;7(4):421-30. doi: 10.3171/2011.1.PEDS10348.
Many children with epilepsy and tuberous sclerosis complex (TSC) have multiple tubers on MR imaging and poorly localized/lateralized video electroencephalography (EEG) findings. Given the long-term risks associated with frequent seizures and multiple antiepileptic drugs, along with improved success in identifying focal epileptogenic zones in patients with multifocal lesions, the authors used bilateral intracranial EEG to lateralize the epileptogenic zone in patients with nonlateralizable noninvasive preoperative evaluations.
A retrospective analysis from January 1, 1998, to June 30, 2008, identified 62 children with TSC who were presented at a surgical conference. Of the 52 patients undergoing diagnostic or therapeutic procedures during the study period, 20 underwent bilateral intracranial EEG. The presurgical testing results, intracranial EEG findings, surgical interventions, and outcomes were reviewed.
Fourteen of 20 patients had intracranial EEG findings consistent with a resectable epileptogenic zone. One patient is awaiting further resection. Five patients had findings consistent with a nonresectable epileptogenic zone, and 1 of these patients underwent a callosotomy. Seven patients had Engel Class I outcomes, 1 was Class II, 3 were Class III, and 3 were Class IV (mean follow-up 25 months).
Bilateral intracranial EEG can identify potential resectable seizure foci in nonlateralizable epilepsy in TSC. Although 6 of 20 patients did not undergo resection (1 patient is pending future resection), significant improvements in seizures (Engel Class I or II) were noted in 8 patients. In the authors' experience, this invasive monitoring provided a safe method for identifying the ictal onset zone.
许多患有癫痫和结节性硬化症（TSC）的儿童在磁共振成像（MR）上有多个结节，且视频脑电图（EEG）检查结果定位不佳/难以定位。鉴于频繁发作和多种抗癫痫药物带来的长期风险，以及在识别多灶性病变患者局灶性癫痫源区方面成功率的提高，作者使用双侧颅内EEG对术前非侵入性评估无法定位癫痫源区的患者进行癫痫源区定位。
对1998年1月1日至2008年6月30日期间在一次外科会议上报告的62例TSC患儿进行回顾性分析。在研究期间接受诊断或治疗程序的52例患者中，20例接受了双侧颅内EEG检查。回顾了术前检查结果、颅内EEG检查结果、手术干预措施和预后情况。
20例患者中有14例的颅内EEG检查结果显示存在可切除的癫痫源区。1例患者等待进一步切除。5例患者的检查结果显示癫痫源区不可切除，其中1例患者接受了胼胝体切开术。7例患者的Engel分级为I级，1例为II级，3例为III级，3例为IV级（平均随访25个月）。
双侧颅内EEG可识别TSC患者无法定位癫痫源区的潜在可切除癫痫病灶。虽然20例患者中有6例未进行切除（1例患者有待未来切除），但8例患者的癫痫发作情况有显著改善（Engel分级为I级或II级）。根据作者的经验，这种侵入性监测为识别发作起始区提供了一种安全的方法。
