Joo Eun Yeon, Seo Dae Won, Hong Seung-Chyul, Hong Seung Bong
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
J Neurol. 2015 May;262(5):1120-9. doi: 10.1007/s00415-014-7625-z. Epub 2015 Mar 21.
The differentiation of combined mesial and lateral temporal onset of seizures (mesio-lateral TLE, MLTLE) from lateral TLE (LTLE) is critical to achieve good surgical outcomes. However, the functional neuroimaging features in LTLE patients based on the ictal onset zone utilizing intracranial EEG (iEEG) in a large series have not been investigated. We enrolled patients diagnosed with MLTLE (n = 35) and LTLE (n = 53) based on the site of ictal onset zone from iEEG monitoring. MLTLE is defined when ictal discharges originate from the mesial and lateral temporal cortices independently, whereas seizures of LTLE arise exclusively from the lateral temporal cortex. Compared to patients with LTLE, patients with MLTLE were more likely to have 18F- fluorodeoxyglucose positron emission tomography (FDG-PET) hypometabolism and hyperperfusion on ictal single-photon emission computed tomography (SPECT) restricted to the temporal areas. MLTLE patients had more frequent aura or secondarily generalized seizures than LTLE patients. No significant differences were found in scalp EEG, MRI, and Wada asymmetry between groups. The overall seizure-free rate was good (73.8%, mean follow-up = 9.7 years), which was not different (Engel class I, 74.3% in MLTLE vs. 73.6% in LTLE). Postsurgical memory function was spared in LTLE patients, while visual memory was impaired in MLTLE patients when their mesial temporal structures were sufficiently resected. It suggests that functional neuroimaging (interictal PET and ictal and interictal SPECT) may play a crucial role to differentiate between MLTLE and LTLE.
将癫痫发作起始于颞叶内侧和外侧联合发作（内侧-外侧颞叶癫痫，MLTLE）与外侧颞叶癫痫（LTLE）相鉴别对于获得良好的手术效果至关重要。然而，尚未对大量基于颅内脑电图（iEEG）的发作起始区的LTLE患者的功能神经影像学特征进行研究。我们根据iEEG监测的发作起始区部位纳入了诊断为MLTLE（n = 35）和LTLE（n = 53）的患者。当发作放电分别起源于颞叶内侧和外侧皮质时定义为MLTLE，而LTLE的发作仅起源于颞叶外侧皮质。与LTLE患者相比，MLTLE患者更有可能出现18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）低代谢以及发作期单光子发射计算机断层扫描（SPECT）显示仅颞叶区域的血流灌注增加。MLTLE患者比LTLE患者有更频繁的先兆或继发全面性发作。两组在头皮脑电图、磁共振成像和Wada试验不对称性方面未发现显著差异。总体无发作率良好（73.8%，平均随访 = 9.7年），两组无差异（Engel I级，MLTLE为74.3%，LTLE为73.6%）。LTLE患者术后记忆功能得以保留，而当MLTLE患者的颞叶内侧结构被充分切除时，其视觉记忆受损。这表明功能神经影像学（发作间期PET以及发作期和发作间期SPECT）可能在鉴别MLTLE和LTLE中起关键作用。
