Spencer S S, Spencer D D, Williamson P D, Mattson R
Department of Neurology, Yale University School of Medicine, New Haven, CT.
Neurology. 1990 Jan;40(1):74-9. doi: 10.1212/wnl.40.1.74.
We used both depth and subdural electrodes to obtain localization of the seizure focus in 47 medically refractory epileptic patients. Seizures were localized in 33 patients. Onset was consistently localized by the depth electrodes in 23 patients, was variable or simultaneous in depth and subdural electrodes in 6 (in the same lobe), and was consistently localized to subdural electrodes in 4. All patients localized with subdural electrodes were extratemporal and 3 of the 4 had lesions on imaging studies which helped guide location of electrode placement. Eighty-seven percent of temporal lobe seizures began in hippocampus (recorded by the depth electrode), and 80% were eventually propagated to the ipsilateral temporal neocortex (recorded by the subdural electrode). In 8 patients with bilateral temporal depth and subdural recording, seizures never spread to the contralateral neocortex before the ipsilateral neocortex. Subdural electrodes were 20% less sensitive than depth electrodes in detection of seizures beginning in hippocampus but were accurate when lateralized. Variable or simultaneous unilateral neocortical versus hippocampal temporal lobe seizure onset, determined by the combined study, was significantly correlated with less favorable seizure control after anteromedial temporal lobectomy and hippocampectomy.
我们使用深部电极和硬膜下电极对47例药物难治性癫痫患者进行癫痫病灶定位。33例患者的癫痫发作得到定位。23例患者的发作起始部位通过深部电极始终能明确，6例患者（在同一脑叶）深部电极和硬膜下电极的定位结果不定或同时出现，4例患者的发作起始部位始终由硬膜下电极定位。所有通过硬膜下电极定位的患者均为颞叶外癫痫，4例中有3例在影像学检查中有病变，这有助于指导电极放置位置。87%的颞叶癫痫发作始于海马体（由深部电极记录），80%最终扩散至同侧颞叶新皮质（由硬膜下电极记录）。在8例双侧颞叶进行深部和硬膜下记录的患者中，癫痫发作在同侧新皮质发作之前从未扩散至对侧新皮质。硬膜下电极在检测始于海马体的癫痫发作时比深部电极敏感度低20%，但在确定发作侧别时是准确的。联合研究确定的颞叶癫痫发作起始于新皮质还是海马体的单侧不定或同时发作情况，与前内侧颞叶切除术和海马切除术术后癫痫控制效果较差显著相关。
