不同棘波发放频率患者中头皮快振荡的发生及其作为致痫性标志物的作用。
Occurrence of scalp-fast oscillations among patients with different spiking rate and their role as epileptogenicity marker.
机构信息
Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada; Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy.
出版信息
Epilepsy Res. 2013 Oct;106(3):345-56. doi: 10.1016/j.eplepsyres.2013.06.003. Epub 2013 Aug 7.
INTRODUCTION
We aim to analyze the fast oscillations in the scalp EEG of focal epilepsy patients with low-to-high rates of interictal epileptiform discharges (IEDs), in order to determine how this neurophysiological feature influences fast oscillation occurrence and their significance as markers of the seizure onset zone (SOZ).
METHODS
Thirty-two patients were studied, subdivided in four categories based on IED frequency: groups A, B and C respectively with high, intermediate and low IED rate, and group D with no IED. Thirty minutes of slow-wave sleep EEG, low-pass filtered at 300Hz and sampled at 1000Hz, were reviewed. IEDs and fast oscillations (gamma activity, 40-80Hz; and ripples, >80Hz) were marked. Each channel was classified as inside or outside the irritative zone and the SOZ. We calculated the number and rates of IEDs and fast oscillation, their co-occurrence, their frequency in the irritative zone and SOZ, and the specificity, sensitivity and accuracy to determine the SOZ in the overall population and separately for each group.
RESULTS
We analyzed 984 channels. Group A (high IED rate) showed the highest fast oscillation rate (gamma: 0.37±0.73; ripples: 0.17±0.26), followed by group B (gamma: 0.08±0.06; ripples: 0.07±0.05), group C (gamma: 0.06±0.06; ripples: 0.04±0.01), and finally group D, with very low values (gamma: 0.03±0; ripples: 0.03±0). IEDs co-occurred with gamma in 9.5% and with ripples in 3.2%; and gamma and ripples co-occurred with IEDs in 46.2% and 44.4%, respectively. The fast oscillations were more frequent inside than outside the irritative zone and the SOZ (p<0.001). Compared to the IEDs, the fast oscillations were less sensitive (sensitivity: IEDs 78%, gamma 66% and ripples 48%) but more specific (specificity: IEDs 50%, gamma 76% and ripples 83%) and accurate (accuracy: IEDs 54%, gamma 74% and ripples 77%) in identifying the SOZ; the same results were reproduced for the different groups separately.
CONCLUSIONS
This study confirms that fast oscillations can be recorded from the scalp EEG. Gamma activity and ripples are more frequent in patients with frequent IEDs and, in general, inside the irritative zone. However, compared to IEDs, gamma and ripples are less sensitive but more specific and accurate in identifying the SOZ, and this remains in patients with low fast oscillation rates. These findings suggest that IEDs and fast oscillations could share some common neuronal network, but gamma activity and ripples are a better biomarker of epileptogenicity.
简介
我们旨在分析具有低至高间发性癫痫样放电 (IED) 率的局灶性癫痫患者头皮 EEG 中的快速振荡，以确定这种神经生理特征如何影响快速振荡的发生及其作为致痫区 (SOZ) 标志物的意义。
方法
研究了 32 名患者，根据 IED 频率将其分为四组：A、B 和 C 组分别为 IED 率高、中、低，D 组无 IED。回顾 30 分钟的慢波睡眠 EEG，以 300Hz 低通滤波，以 1000Hz 采样。标记 IED 和快速振荡（γ活动，40-80Hz；和涟漪，>80Hz）。每个通道被分类为兴奋区和 SOZ 内或外。我们计算了 IED 和快速振荡的数量和速率、它们的共现、它们在兴奋区和 SOZ 中的频率，以及在总体人群和每组中的特异性、敏感性和准确性，以确定 SOZ。
结果
我们分析了 984 个通道。A 组（高 IED 率）表现出最高的快速振荡率（γ：0.37±0.73；涟漪：0.17±0.26），其次是 B 组（γ：0.08±0.06；涟漪：0.07±0.05），C 组（γ：0.06±0.06；涟漪：0.04±0.01），最后是 D 组，值非常低（γ：0.03±0；涟漪：0.03±0）。IEDs 与 γ 共现的频率为 9.5%，与涟漪共现的频率为 3.2%；γ 和涟漪与 IEDs 共现的频率分别为 46.2%和 44.4%。快速振荡在兴奋区和 SOZ 内比兴奋区和 SOZ 外更频繁（p<0.001）。与 IEDs 相比，快速振荡的敏感性较低（敏感性：IEDs 78%，γ 66%和涟漪 48%），但特异性较高（特异性：IEDs 50%，γ 76%和涟漪 83%）和准确性较高（准确性：IEDs 54%，γ 74%和涟漪 77%），可识别 SOZ；分别对不同的组重复了相同的结果。
结论
本研究证实，快速振荡可以从头皮 EEG 中记录下来。γ 活动和涟漪在 IED 频繁的患者中更为频繁，通常在兴奋区内部。然而，与 IEDs 相比，γ 和涟漪的敏感性较低，但特异性和准确性较高，可识别 SOZ，在 IED 快速振荡率较低的患者中也是如此。这些发现表明，IEDs 和快速振荡可能共享一些共同的神经网络，但 γ 活动和涟漪是更好的致痫性生物标志物。
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