Iimura Yasushi, Jones Kevin, Hattori Kyoko, Okazawa Yushi, Noda Atsuko, Hoashi Kana, Nonoda Yutaka, Asano Eishi, Akiyama Tomoyuki, Go Cristina, Ochi Ayako, Snead O Carter, Donner Elizabeth J, Rutka James T, Drake James M, Otsubo Hiroshi
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
Clin Neurophysiol. 2017 Jul;128(7):1197-1205. doi: 10.1016/j.clinph.2017.03.031. Epub 2017 Mar 24.
Subtotal hemispherectomy involves the resection of multiple lobes in children with drug-resistant epilepsy, skipping the motor area (MA). We determined epileptogenicity using the occurrence rate (OR) of high-frequency oscillations (HFOs) and the modulation index (MI), demonstrating strength of coupling between HFO and slow wave. We hypothesized that epileptogenicity increased over the multiple lobes but skipped the MA.
We analyzed 23 children (14 subtotal hemispherectomy; 9 multilobar resections). Scalp video-EEG and magnetoencephalography were performed before surgery. We analyzed the OR and MI on electrodes of total area, resection areas, and MA. We compared the data between good [International League Against Epilepsy (ILAE) class I-II] and poor (III-VI) seizure outcome groups.
ILAE class Ia outcome was achieved in 18 children. Among the MI in the resection areas, MI was the highest. The OR and MI in both total area and resection areas were significantly higher in the good seizure outcome group than in the poor outcome group. The OR and MI in resection areas were significantly higher than in the MA.
Our patients with multilobar drug-resistant epilepsy showed evidence of multifocal epileptogenicity that specifically skipped the MA.
This is the first study demonstrating that the electrophysiological phenotype of multifocal epilepsy specifically skips the MA using OR and MI.
大脑半球次全切除术涉及对耐药性癫痫患儿多个脑叶的切除，避开运动区（MA）。我们使用高频振荡（HFOs）的发生率（OR）和调制指数（MI）来确定致痫性，MI显示了HFO与慢波之间的耦合强度。我们假设致痫性在多个脑叶中增加，但避开了运动区。
我们分析了23名儿童（14例行大脑半球次全切除术；9例行多脑叶切除术）。术前进行头皮视频脑电图和脑磁图检查。我们分析了总面积、切除区域和运动区电极上的OR和MI。我们比较了癫痫发作结果良好[国际抗癫痫联盟（ILAE）I-II级]和不良（III-VI级）组之间的数据。
18名儿童达到了ILAE Ia级结果。在切除区域的MI中，MI最高。癫痫发作结果良好组的总面积和切除区域的OR和MI均显著高于不良结果组。切除区域的OR和MI显著高于运动区。
我们的多脑叶耐药性癫痫患者显示出多灶性致痫性的证据，具体表现为避开了运动区。
这是第一项使用OR和MI证明多灶性癫痫的电生理表型具体避开运动区的研究。
