CHU Timone, Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France.
CHU Timone, Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille F-13005, France; INSERM, U1106, Marseille F-13005, France; Aix Marseille Université, Faculté de Médecine, Marseille F-13005, France.
Epilepsy Res. 2014 May;108(4):701-8. doi: 10.1016/j.eplepsyres.2014.02.018. Epub 2014 Mar 12.
The relationship between epileptogenic lesions and the extension of epileptogenicity is a major challenge in presurgical evaluation of drug resistant epilepsies. In this study, we aimed at quantifying the epileptogenic properties of brain structures explored by depth electrodes in patients investigated by stereoelectroencephalography (SEEG) and suffering from focal drug-resistant epilepsy associated with cavernous angioma (CA). Epileptogenicity of the perilesional region and distant brain areas was calculated according to the "epileptogenicity index" (EI), a technique that allows mathematical quantification of rapid discharges at seizure onset taking into account the time at which the discharge occurs. Thirteen seizures from 6 patients were studied. Localization of the cavernoma was the frontal lobe (two cases), the temporal lobe (three cases) or the anterior insula (one case). Visual inspection of the ictal discharge showed that in the majority of cases (5/6) the perilesional region was either not involved or involved with other distant sites. Using EI quantification, complex patterns of epileptogenicity were observed in five patients. A large number of brain regions out of the lesional region disclosed higher values than the lesion site. Mean values in the perilesional region and in the extralesional sites were not significantly different (p=0.34). Complex organization of the epileptogenic zone may be found in drug-resistant CA associated epilepsy. Thus, this result should be borne in mind when patients with CA and drug resistant epilepsy are investigated. If there is a suspicion of a larger epileptogenic zone than the lesion, intra-cerebral exploration by SEEG may be required before surgery that may be guided by the definition of the EZ.
致痫病变与致痫性扩展之间的关系是耐药性癫痫术前评估的主要挑战。本研究旨在量化接受立体脑电图(SEEG)检查并患有伴海绵状血管瘤(CA)的局灶性耐药性癫痫患者中深度电极所探查的脑结构的致痫特性。根据“致痫指数”(EI)计算病变周围区域和远隔脑区的致痫性,这一技术允许考虑放电发生的时间,对发作起始时的快速放电进行数学量化。研究了 6 名患者的 13 次癫痫发作。海绵状血管瘤的定位为额叶(2 例)、颞叶(3 例)或前岛叶(1 例)。对发作放电的视觉检查显示,在大多数情况下(5/6),病变周围区域要么没有参与,要么与其他远隔部位参与。使用 EI 量化,在 5 名患者中观察到复杂的致痫性模式。大量的脑区显示出比病变部位更高的值。病变周围区域和病变外部位的平均值无显著差异(p=0.34)。耐药性 CA 相关癫痫可能存在致痫区的复杂组织。因此,当 CA 伴耐药性癫痫患者接受检查时,应考虑到这一结果。如果怀疑致痫区大于病变,可能需要进行颅内 SEEG 探查,以指导 EZ 的定义。