Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada.
McGill University, 845 Sherbrooke St W, Montréal, QC H3A 0G4, Canada.
Clin Neurophysiol. 2018 Jun;129(6):1311-1319. doi: 10.1016/j.clinph.2018.02.003. Epub 2018 Feb 22.
There are different neurophysiological markers of the Epileptogenic Zone (EZ), but their sensitivity and specificity for the EZ is not known in Focal Cortical Dysplasia (FCD) patients.
We studied patients with FCD who underwent stereoelectroencephalography (SEEG) and surgery. We marked in the SEEG: (a) typical and atypical interictal epileptiform patterns, (b) ictal onset patterns, and (c) rates of ripples (80-250 Hz) and fast ripples (FRs) (>250 Hz). High frequency oscillations were marked automatically during one hour of deep sleep. Surgical outcome was defined as good (Engel I) or poor (Engel II-IV). We computed the sensitivity and, as a measure of specificity, the false positive rate to identify the EZ, and compared them across the different neurophysiological markers.
We studied 21 patients, 19 with FCD II. Ictal and typical interictal pattern were the markers with highest sensitivity, while the atypical interictal pattern had the lowest. We found no significant difference in specificity among markers. However, there is a tendency that FRs had the lowest false positive rate.
The typical interictal pattern has the highest sensitivity. The clinical use of FRs is limited by their low sensitivity.
We suggest to analyze the typical interictal pattern first. FRs should be analyzed in a second step. If, for instance, a focus with FRs and no typical interictal pattern is found, this area could be considered for resection.
致痫区（EZ）有不同的神经生理学标志物，但在局灶性皮质发育不良（FCD）患者中，其对 EZ 的敏感性和特异性尚不清楚。
我们研究了接受立体脑电图（SEEG）和手术的 FCD 患者。我们在 SEEG 中标记：（a）典型和非典型的发作间期癫痫样模式，（b）发作起始模式，和（c）棘波（80-250Hz）和快棘波（FRs）（>250Hz）的频率。高频振荡在深睡眠的一小时内自动标记。手术结果定义为良好（Engel I）或不良（Engel II-IV）。我们计算了识别 EZ 的敏感性，并作为特异性的衡量标准，计算了假阳性率，并比较了不同神经生理学标志物之间的差异。
我们研究了 21 例患者，其中 19 例为 FCD II 型。发作期和典型发作间期模式是敏感性最高的标志物，而非典型发作间期模式的敏感性最低。我们发现标志物之间的特异性没有显著差异。然而，FRs 的假阳性率似乎较低。
典型发作间期模式的敏感性最高。FRs 的临床应用受到其低敏感性的限制。
我们建议首先分析典型发作间期模式。如果发现存在 FRs 而无典型发作间期模式的病灶，则应进行第二步分析。如果发现这样一个区域，可以考虑将其切除。
