Palmigiano Agostina, Pastor Jesús, Sola Rafael G, Ortega Guillermo J
Hospital Universitario de la Princesa, 28006 Madrid, Espana.
Rev Neurol. 2012 Aug 16;55(4):207-16.
Locating and excising epileptogenic zones is the traditional treatment in pharmacoresistant temporal lobe epilepsy. Some patients, however, continue to suffer from attacks even after surgery. Therefore, new hypotheses must be formulated in order to account for the apparent shortcomings of correctly performed surgical procedures.
An approach that is not traditional in the field, namely complex networks, is used to attempt to show that modifying the properties of the limbic network can lead to the elimination of the attacks, regardless of the location of the epileptogenic zones.
The intraoperative electrocorticographic recordings of 20 patients with pharmacoresistant temporal lobe epilepsy were utilised in the study. An analysis of complex networks was used to study the local synchronisation activity in the lateral and mesial cortex of the temporal lobe and, essentially, the zones with the highest temporal stability were determined.
Those cortical zones with higher synchronic activity are associated with a greater temporal stability and when these zones are excised during surgery, the patient no longer suffers any disabling attacks. In contrast, when these zones are not excised, the patient continues to have attacks in the post-operative period.
The findings support the hypothesis of the existence of a limbic network, which the lateral and mesial cortices of the temporal lobe are part of, and whose capacity to establish an overall synchronisation is affected when certain zones are removed.
定位并切除致痫区是药物难治性颞叶癫痫的传统治疗方法。然而，一些患者即使在手术后仍继续发作。因此，必须提出新的假设来解释正确实施的手术程序明显存在的不足之处。
采用该领域非传统的方法，即复杂网络，试图表明改变边缘系统网络的属性可导致发作消除，而不论致痫区的位置如何。
本研究使用了20例药物难治性颞叶癫痫患者的术中皮质脑电图记录。采用复杂网络分析来研究颞叶外侧和内侧皮质的局部同步活动，并确定本质上具有最高时间稳定性的区域。
那些具有较高同步活动的皮质区域与更高的时间稳定性相关，并且在手术中切除这些区域时，患者不再遭受任何致残性发作。相反，当这些区域未被切除时，患者在术后仍会发作。
这些发现支持存在边缘系统网络的假设，颞叶外侧和内侧皮质是该网络的一部分，当某些区域被切除时，其建立整体同步的能力会受到影响。
