Mohammadi Mahmoud, Okanishi Tohru, Okanari Kazuo, Baba Shiro, Sumiyoshi Hironobu, Sakuma Satoru, Ochi Ayako, Widjaja Elysa, Go Cristina Y, Snead O Carter, Otsubo Hiroshi
Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatric Neurology, Children's Medical Center, Tehran, Iran.
Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
Brain Dev. 2015 Jan;37(1):59-65. doi: 10.1016/j.braindev.2014.03.006. Epub 2014 May 5.
Generalized paroxysmal fast activity (GPFA) consists of burst of generalized rhythmic discharges; 100-200 μV; 1-9s; 8-26 Hz; with frontal predominance; appearing during NREM sleep. GPFA was originally described as an electrographic feature of Lennox-Gastaut Syndrome (LGS). We analyzed GPFA on scalp video EEG (VEEG) in children to evaluate that GPFA presents in patients with intractable localization-related epilepsy.
We collected cases with GPFA with intractable localization-related epilepsy who underwent scalp VEEG, MRI, and magnetoencephalography (MEG) prior to intracranial video EEG (IVEEG) and surgical resection. We collected 50 epochs of GPFA per patient during the first night during scalp VEEG. We analyzed amplitude, duration and frequency of GPFA over the bilateral frontal region between surgical resection side with grid placement and non-resection side.
We identified 14 (14%) patients with GPFA on scalp VEEG. The mean amplitude ranged from 145 to 589 μV (mean 293 μV). The mean duration ranged from 1.18 to 2.31s (mean 1.6s). The mean frequencies ranged from 9.3 to 14.7 Hz (mean 11.1 Hz). The amplitude (307 ± 156 μV) and duration (1.62 ± 0.8s) of GPFAs in all the patients over the resection side were significantly higher than those (279 ± 141 μV, 1.58 ± 0.8s) of the non-resection side (p<0.001). All nine patients who showed significant duration differences between two hemispheres (p<0.05) had longer duration of GPFA over the resection side. Eight of 12 patients who showed significant amplitude differences between two hemispheres (p<0.05) had higher amplitude of GPFA over the resection side. Four of six patients who showed significant frequency differences between two hemispheres (p<0.05) had higher frequency of GPFA over the resection side. Nine (64%) patients became seizure free after surgical resection including multilobar resections in eight patients.
GPFA can exist in localization-related epilepsy with secondary bilateral synchrony. Although EEG shows GPFA on scalp VEEG, the precise localization of the epileptogenic zone using IVEEG could achieve the successful surgical resection.
广泛性阵发性快速活动（GPFA）由广泛性节律性放电组成；电压100 - 200μV；持续时间1 - 9秒；频率8 - 26赫兹；以额部为主；出现在非快速眼动睡眠期。GPFA最初被描述为Lennox - Gastaut综合征（LGS）的一种脑电图特征。我们对儿童头皮视频脑电图（VEEG）上的GPFA进行分析，以评估其在难治性局灶性相关性癫痫患者中的表现。
我们收集了患有GPFA且为难治性局灶性相关性癫痫的病例，这些病例在进行颅内视频脑电图（IVEEG）和手术切除之前接受了头皮VEEG、磁共振成像（MRI）和脑磁图（MEG）检查。在头皮VEEG的第一个晚上，我们为每位患者收集50个GPFA发作期。我们分析了在放置电极栅的手术切除侧与非切除侧的双侧额叶区域的GPFA的幅度、持续时间和频率。
我们在头皮VEEG上识别出14例（14%）患有GPFA的患者。平均幅度范围为145至589μV（平均293μV）。平均持续时间范围为1.18至2.31秒（平均1.6秒）。平均频率范围为9.3至14.7赫兹（平均11.1赫兹）。所有患者手术切除侧的GPFA的幅度（307±156μV）和持续时间（1.62±0.8秒）显著高于非切除侧（279±141μV，1.58±0.8秒）（p<0.001）。在两个半球之间显示出持续时间有显著差异（p<0.05）的所有9例患者中，手术切除侧的GPFA持续时间更长。在两个半球之间显示出幅度有显著差异（p<0.05）的12例患者中有8例，手术切除侧的GPFA幅度更高。在两个半球之间显示出频率有显著差异（p<0.05）的6例患者中有4例，手术切除侧的GPFA频率更高。9例（64%）患者在手术切除后无癫痫发作，其中8例患者进行了多叶切除。
GPFA可存在于伴有继发性双侧同步性的局灶性相关性癫痫中。尽管脑电图在头皮VEEG上显示有GPFA，但使用IVEEG对致痫区进行精确定位可实现成功的手术切除。
