Kokkinos Vasileios, Koupparis Andreas M, Koutroumanidis Michalis, Kostopoulos George K
Department of Clinical Neurophysiology and Epilepsies, Guy's, St Thomas' and Evelina Hospital for Children, NHS Foundation Trust, London, United Kingdom; Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece.
Neurophysiology Unit, Department of Physiology, Medical School, University of Patras, Greece.
Clin Neurophysiol. 2017 Sep;128(9):1553-1562. doi: 10.1016/j.clinph.2017.05.021. Epub 2017 Jun 17.
This work investigates the spatial distribution in time of generalized ictal spikes in the typical absences of childhood absence epilepsy (CAE).
We studied twelve children with CAE, who had more than two typical absences during their routine video-EEG. Seizures were identified, and ictal spikes were marked over the maximum electronegative peak, clustered, waveform-averaged and spatiotemporaly analyzed in 2D electrode space.
Consistency of spatiotemporal patterns of ictal spikes was high between the absences of the same child, but low between children. Three main discharge patterns were identified: of anterio-posterior propagation, of posterio-anterior propagation and confined to the frontal/prefrontal regions. In 4 patients, the propagation patterns transformed during the seizure into either a lateralized diminished or a non-lateralized reverse direction form. Most spikes originated fronto-temporaly, all maximized over the frontal/prefrontal electrodes and mostly decayed prefrontaly. In 4 patients, lateralized propagation patterns were identified.
Ictal spike propagation patterns suggest that epileptogenic CAE networks are personalized, interconnect distal areas in the brain - not the entire cortex - with a tendency to generate bilateral symmetrical discharges, sometimes unsuccessfully. The transformation of propagation patterns during the seizure indicates the existence of dynamic interplay within epileptogenic networks.
Our results support the revised concept of ictogenesis of ILAE definition in genetic (also known as idiopathic) generalized epilepsies. Understanding the focal features in CAE avoids misdiagnosis as focal epilepsy and inappropriate treatment.
本研究调查儿童失神癫痫（CAE）典型失神发作时广义发作期棘波的时空分布情况。
我们研究了12名患有CAE的儿童，他们在常规视频脑电图检查期间有两次以上典型失神发作。识别出癫痫发作，并在最大负电峰值处标记发作期棘波，在二维电极空间中进行聚类、波形平均和时空分析。
同一儿童不同失神发作之间发作期棘波的时空模式一致性较高，但不同儿童之间的一致性较低。识别出三种主要放电模式：前后传播模式、后前传播模式和局限于额叶/前额叶区域的模式。在4例患者中，发作期间传播模式转变为侧化减弱或非侧化反向形式。大多数棘波起源于额颞部，均在额叶/前额叶电极上达到最大值，且大多在前额叶衰减。在4例患者中，识别出侧化传播模式。
发作期棘波传播模式表明，致痫性CAE网络是个性化的，连接大脑中远端区域——而非整个皮质——且倾向于产生双侧对称放电，有时并不成功。发作期间传播模式的转变表明致痫网络内存在动态相互作用。
我们的结果支持国际抗癫痫联盟（ILAE）对遗传性（也称为特发性）全身性癫痫发作起源定义的修订概念。了解CAE中的局灶性特征可避免误诊为局灶性癫痫和不适当的治疗。
