Liu Chunyan, Zhang Ruihua, Zhang Guojun, Yu Tao, Tai Junli, Du Wei, Li Liping, Wang Yuping
Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China.
Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China; Department of Functional Neurology, Lu He Hospital, Capital Medical University, Beijing 101149, China.
Epilepsy Res. 2016 Nov;127:233-240. doi: 10.1016/j.eplepsyres.2016.09.006. Epub 2016 Sep 5.
In some cases of single focus epilepsy, conventional video electroencephalography (EEG) cannot reveal the epileptogenic focus even when intracranial electrodes are used. Here, we tested whether analyzing high frequency oscillations (HFOs) can be used to determine the ictal onset zone in suspected bitemporal epilepsy and improve seizure outcome.
We prospectively studied 13 patients with refractory temporal seizures who were treated over a 4-year period and underwent bilateral placement of intracranial electrodes. Subdural strips were used in all cases, and depth electrodes were implanted into mesial temporal lobes in 10 patients. The mean patient age was 30.92 years, and 30.7% of patients were male. Patients were monitored by conventional and wide-band frequency amplifiers.
Conventional invasive EEG monitoring of interictal periods showed bilateral epileptiform abnormalities in 12 patients (92.3%) and unilateral epileptiform abnormalities in one (7.7%), and monitoring of ictal periods revealed unilateral seizure origins in nine patients (69.2%) and bilateral origins in four (30.8%). In contrast, high frequency invasive EEG monitoring of interictal periods showed bilateral HFOs in seven patients (53.8%) and unilateral HFOs in six (46.2%), and monitoring of ictal periods revealed unilateral HFOs in all 10 patients who were tested. Three patients were not monitored during ictal periods because of time limitations. All 13 patients subsequently underwent a standard unilateral temporal lobectomy and have been followed-up for a minimum of 12 months. Eleven (84%) had a Class I outcome, one (8%) a Class II outcome, and one a Class III outcome.
Bilateral placement of subdural strip and depth electrodes for seizure monitoring in patients with suspected bitemporal epilepsy is both safe and effective. Monitoring high frequency oscillations can help determine the laterality of the onset zone when localization using conventional EEG or brain MRI fails.
在某些单灶性癫痫病例中，即使使用颅内电极，传统视频脑电图（EEG）也无法揭示致痫灶。在此，我们测试了分析高频振荡（HFOs）是否可用于确定疑似双侧颞叶癫痫的发作起始区并改善癫痫发作结果。
我们前瞻性地研究了13例难治性颞叶癫痫患者，这些患者在4年期间接受治疗并双侧植入颅内电极。所有病例均使用硬膜下条带电极，10例患者在颞叶内侧植入深度电极。患者平均年龄为30.92岁，30.7%为男性。患者通过传统和宽带频率放大器进行监测。
传统侵入性EEG间期监测显示，12例患者（92.3%）有双侧癫痫样异常，1例（7.7%）有单侧癫痫样异常；发作期监测显示，9例患者（69.2%）发作起源于单侧，4例（30.8%）起源于双侧。相比之下，高频侵入性EEG间期监测显示，7例患者（53.8%）有双侧HFOs，6例（46.2%）有单侧HFOs；发作期监测显示，所有接受测试的10例患者均有单侧HFOs。由于时间限制，3例患者在发作期未进行监测。所有13例患者随后均接受了标准的单侧颞叶切除术，并至少随访了12个月。11例（84%）预后为I级，1例（8%）为II级，1例为III级。
对于疑似双侧颞叶癫痫患者，双侧放置硬膜下条带电极和深度电极进行癫痫发作监测既安全又有效。当使用传统EEG或脑MRI定位失败时，监测高频振荡有助于确定发作起始区的侧别。
