发作期高频振荡可区分人类两种类型的致痫灶。
Ictal high frequency oscillations distinguish two types of seizure territories in humans.
机构信息
1 Department of Neurology, Columbia University, New York, NY, USA.
出版信息
Brain. 2013 Dec;136(Pt 12):3796-808. doi: 10.1093/brain/awt276. Epub 2013 Oct 30.
High frequency oscillations have been proposed as a clinically useful biomarker of seizure generating sites. We used a unique set of human microelectrode array recordings (four patients, 10 seizures), in which propagating seizure wavefronts could be readily identified, to investigate the basis of ictal high frequency activity at the cortical (subdural) surface. Sustained, repetitive transient increases in high gamma (80-150 Hz) amplitude, phase-locked to the low-frequency (1-25 Hz) ictal rhythm, correlated with strong multi-unit firing bursts synchronized across the core territory of the seizure. These repetitive high frequency oscillations were seen in recordings from subdural electrodes adjacent to the microelectrode array several seconds after seizure onset, following ictal wavefront passage. Conversely, microelectrode recordings demonstrating only low-level, heterogeneous neural firing correlated with a lack of high frequency oscillations in adjacent subdural recording sites, despite the presence of a strong low-frequency signature. Previously, we reported that this pattern indicates a failure of the seizure to invade the area, because of a feedforward inhibitory veto mechanism. Because multi-unit firing rate and high gamma amplitude are closely related, high frequency oscillations can be used as a surrogate marker to distinguish the core seizure territory from the surrounding penumbra. We developed an efficient measure to detect delayed-onset, sustained ictal high frequency oscillations based on cross-frequency coupling between high gamma amplitude and the low-frequency (1-25 Hz) ictal rhythm. When applied to the broader subdural recording, this measure consistently predicted the timing or failure of ictal invasion, and revealed a surprisingly small and slowly spreading seizure core surrounded by a far larger penumbral territory. Our findings thus establish an underlying neural mechanism for delayed-onset, sustained ictal high frequency oscillations, and provide a practical, efficient method for using them to identify the small ictal core regions. Our observations suggest that it may be possible to reduce substantially the extent of cortical resections in epilepsy surgery procedures without compromising seizure control.
高频振荡已被提议作为一种有临床应用价值的致痫灶生物标志物。我们使用了一组独特的人类微电极阵列记录(四名患者,十次癫痫发作),其中可以轻易识别传播的癫痫波阵面,以研究皮质(硬膜下)表面癫痫高频活动的基础。与低频(1-25 Hz)癫痫节律锁相的高γ(80-150 Hz)振幅的持续、重复的瞬态增加与核心癫痫区域内的多单位爆发同步的强放电相关。这些重复的高频振荡在癫痫发作开始后几秒钟,在癫痫波阵面通过后,从靠近微电极阵列的硬膜下电极记录中可以看到。相反,只有低水平、异质性神经放电的微电极记录与相邻硬膜下记录部位缺乏高频振荡相关,尽管存在强烈的低频特征。以前,我们报道过这种模式表明癫痫未能侵入该区域,因为存在前馈抑制否决机制。由于多单位放电率和高γ振幅密切相关,高频振荡可以作为替代标志物来区分核心癫痫区域和周围半影区。我们开发了一种有效的方法来检测延迟发作的、持续的癫痫高频振荡,基于高γ振幅与低频(1-25 Hz)癫痫节律之间的交叉频率耦合。当应用于更广泛的硬膜下记录时,该方法始终可以预测癫痫入侵的时间或失败,并揭示了一个令人惊讶的小而缓慢扩散的癫痫核心区域,周围是一个更大的半影区域。因此,我们的发现确定了延迟发作的、持续的癫痫高频振荡的潜在神经机制,并提供了一种实用、高效的方法来利用它们识别小的癫痫核心区域。我们的观察表明,在不影响癫痫控制的情况下,有可能在癫痫手术中大幅减少皮质切除的范围。