Tatum William O, Dionisio Jenna B, Vale Fernando L
*Department of Neurology, Mayo Clinic, Jacksonville, Florida, U.S.A.; and †Department of Neurosurgery, University of South Florida, Tampa, Florida, U.S.A.
J Clin Neurophysiol. 2015 Apr;32(2):139-46. doi: 10.1097/WNP.0000000000000135.
To assess the use of subdural intracranial EEG (iEEG) on postoperative outcomes at an epilepsy center.
Ninety-one epilepsy patients underwent iEEG. Array design was compared with noninvasive EEG with over 1 year of outcome. Patient demographics, implanted brain sites, electrodes, contacts/site, and surgical location were correlated with outcome. Fisher exact test and logistics regression were used to evaluate significance (P ≤ 0.05).
Of ninety-one women, 55 (mean age, 32.3 years; range, 11-60) underwent tailored iEEG. Seventy of ninety-one (76.9%) resections (70% temporal) yielded 24/91 (26.4%) seizure free (SF). Strips (57.1%), grids (5.5%), or both (37.4%) for iEEG use was commonly bilateral (58.2%; 65.3% bitemporal) but did not predict outcome (P = NS). A lesion (28/91) did predict a SF outcome (42.9%). The iEEG localized 45.7% of seizures beyond scalp EEG and changed the localization or lateralization in 75.7% of resected patients. Electrode design, localization, lateralization, and site of resection did not correlate with outcome (P = NS). Overall, iEEG use portended a non-SF outcome (P ≤ 0.0001).
The use of iEEG selected 46% additional patients for surgery, yet only 26% became SF. A magnetic resonance imaging lesion predicted a SF or seizure-improved outcome. Although iEEG changed the localization and lateralization of scalp ictal EEG in three quarters of patients, its use was a negative predictor for a favorable outcome. Preoperative counseling should emphasize expectations for seizure reduction in patients requiring iEEG.
评估硬膜下颅内脑电图（iEEG）在癫痫中心对术后结局的应用情况。
91例癫痫患者接受了iEEG检查。将阵列设计与非侵入性脑电图进行了超过1年的结局比较。患者人口统计学特征、植入脑区、电极、触点/部位以及手术位置与结局相关。采用Fisher精确检验和逻辑回归评估显著性（P≤0.05）。
91例女性患者中，55例（平均年龄32.3岁；范围11 - 60岁）接受了定制的iEEG检查。91例中有70例（76.9%）切除手术（70%为颞叶），其中24例（26.4%）实现无癫痫发作（SF）。用于iEEG的条形电极（57.1%）、网格电极（5.5%）或两者皆用（37.4%）通常为双侧（58.2%；双侧颞叶为65.3%），但不能预测结局（P =无显著性差异）。有病变（28/91）确实可预测SF结局（42.9%）。iEEG能定位超出头皮脑电图的45.7%的癫痫发作，并在75.7%的切除患者中改变了定位或定侧。电极设计、定位、定侧以及切除部位与结局无关（P =无显著性差异）。总体而言，使用iEEG预示着非SF结局（P≤0.0001）。
使用iEEG使额外46%的患者接受了手术，但只有26%实现了SF。磁共振成像病变可预测SF或癫痫改善结局。尽管iEEG在四分之三的患者中改变了头皮发作期脑电图的定位和定侧，但其应用是良好结局的负面预测指标。术前咨询应向需要iEEG的患者强调对癫痫发作减少的预期。
