Gollwitzer Stephanie, Scott Catherine A, Farrell Fiona, Bell Gail S, de Tisi Jane, Walker Matthew C, Wehner Tim, Sander Josemir W, Hamer Hajo M, Diehl Beate
NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom.
Epilepsy Behav. 2017 Mar;68:17-21. doi: 10.1016/j.yebeh.2016.12.027. Epub 2017 Jan 18.
Bilateral interictal epileptiform discharges (IED) and ictal patterns are common in temporal lobe epilepsy (TLE) and have been associated with decreased chances of seizure freedom after epilepsy surgery. It is unclear whether secondary epileptogenesis, although demonstrated in experimental models, exists in humans and may account for progression of epilepsy.
We reviewed consecutive video-EEG recordings from 1992 to 2014 repeated at least two years apart (mean interval 6.14years) in 100 people diagnosed with TLE.
Ictal EEG patterns and IED remained restricted to one hemisphere in 36 people (group 1), 46 exhibited bilateral abnormalities from the first recording (group 2), 18 progressed from unilateral to bilateral EEG pathology over time (group 3). No significant differences between the three groups were seen with respect to age at epilepsy onset, duration, or underlying pathology. Extra-temporal IED during the first EEG recording were associated with an increased risk of developing bilateral epileptiform changes over time (hazard ratio 3.67; 95% CI 1.4, 9.4).
Our findings provide some support of progression in TLE and raise the possibility of secondary epileptogenesis in humans. The development of an independent contra-lateral epileptogenic focus is known to be associated with a less favorable surgical outcome. We defined reliable EEG markers for an increased risk of progression to more widespread or independent bitemporal epileptogenicity at an early stage, thus allowing for individualized pre-surgical counselling.
双侧发作间期癫痫样放电（IED）和发作期模式在颞叶癫痫（TLE）中很常见，并且与癫痫手术后无癫痫发作的几率降低有关。目前尚不清楚继发性癫痫发生，尽管在实验模型中已得到证实，但在人类中是否存在，以及是否可解释癫痫的进展。
我们回顾了1992年至2014年期间对100例诊断为TLE的患者进行的连续视频脑电图记录，记录间隔至少为两年（平均间隔6.14年）。
36例患者（第1组）的发作期脑电图模式和IED仍局限于一个半球，46例从首次记录开始就表现出双侧异常（第2组），18例随着时间的推移从单侧脑电图病变进展为双侧病变（第3组）。三组在癫痫发作起始年龄、病程或潜在病理方面未见显著差异。首次脑电图记录期间的颞叶外IED与随着时间推移出现双侧癫痫样改变的风险增加相关（风险比3.67；95%可信区间1.4, 9.4）。
我们的研究结果为TLE的进展提供了一些支持，并增加了人类继发性癫痫发生的可能性。已知独立对侧癫痫灶的形成与较差的手术结果相关。我们定义了可靠的脑电图标志物，用于早期预测进展为更广泛或独立的双侧颞叶癫痫源性的风险增加，从而实现个性化的术前咨询。
