1 Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China ; 2 Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China ; 3 Department of Neurology, Beijing Key Laboratory of Neuromodulation, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Ann Transl Med. 2016 Jan;4(2):24. doi: 10.3978/j.issn.2305-5839.2015.12.65.
Up to a third of all patients with epilepsy are refractory to medical therapy even in the context of the introduction of new antiepileptic drugs (AEDs) with considerable advantages in safety and tolerability over the last two decades. It has been widely accepted that epilepsy surgery is a highly effective therapeutic option in a selected subset of patients with refractory focal seizure. There is no doubt that accurate localization of the epileptogenic zone (EZ) is crucial to the success of resection surgery for intractable epilepsy. The pre-surgical evaluation requires a multimodality approach wherein each modality provides unique and complimentary information. Accurate localization of EZ still remains challenging, especially in patients with normal features on MRI. Whereas substantial progress has been made in the methods of pre-surgical assessment in recent years, which widened the applicability of surgical treatment for children and adults with refractory seizure. Advances in neuroimaging including voxel-based morphometric MRI analysis, multimodality techniques and computer-aided subtraction ictal SPECT co-registered to MRI have improved our ability to identify subtle structural and metabolic lesions causing focal seizure. Considerable observations from animal model with epilepsy and pre-surgical patients have consistently found a strong correlation between high frequency oscillations (HFOs) and epileptogenic brain tissue that suggest HFOs could be a potential biomarker of EZ. Since SEEG emphasizes the importance to study the spatiotemporal dynamics of seizure discharges, accounting for the dynamic, multidirectional spatiotemporal organization of the ictal discharges, it has greatly deep our understanding of the anatomo-electro-clinical profile of seizure. In this review, we focus on some state-of-the-art pre-surgical investigations that contribute to the precision medicine. Furthermore, advances also provide opportunity to achieve the minimal side effects and maximal benefit individually, which meets the need for the current concept of precision medicine in epilepsy surgery.
多达三分之一的癫痫患者即使在过去二十年中具有安全性和耐受性优势的新型抗癫痫药物（AEDs）引入的情况下，对药物治疗仍无反应。人们普遍认为，癫痫手术是一种非常有效的治疗选择，适用于少数难治性局灶性癫痫患者。毫无疑问，准确确定致痫区（EZ）对于难治性癫痫切除术的成功至关重要。术前评估需要采用多模态方法，其中每种方法都提供独特且互补的信息。EZ 的准确定位仍然具有挑战性，尤其是在 MRI 上具有正常特征的患者中。尽管近年来在术前评估方法方面取得了实质性进展，扩大了手术治疗对儿童和成人难治性癫痫的适用性。神经影像学的进步，包括基于体素的形态计量 MRI 分析、多模态技术和计算机辅助发作期 SPECT 与 MRI 减影，提高了我们识别导致局灶性癫痫的细微结构和代谢性病变的能力。癫痫动物模型和术前患者的大量观察结果一致发现高频振荡（HFOs）与致痫性脑组织之间存在很强的相关性，这表明 HFOs 可能是 EZ 的潜在生物标志物。由于 SEEG 强调了研究癫痫发作放电的时空动力学的重要性，考虑到发作放电的动态、多向时空组织，它极大地加深了我们对发作的解剖-电-临床特征的理解。在这篇综述中，我们重点介绍了一些有助于精准医学的最新术前研究。此外，这些进展还为实现个体化最小副作用和最大获益提供了机会，这符合当前癫痫手术精准医学的概念需求。
