Department of Neurosurgery, Yale University, New Haven, CT, USA.
Department of Neurosurgery, Yale University, New Haven, CT, USA.
Lancet Neurol. 2018 Apr;17(4):373-382. doi: 10.1016/S1474-4422(18)30031-0. Epub 2018 Mar 13.
Intracranial electrophysiological recording in patients with refractory focal epilepsy is the gold standard for defining epileptogenic tissue. Although the concordance of intracranial electrophysiology, structural MRI, and pathology can identify brain regions for resection, complete seizure control after surgery is not achieved in all patients with focal epilepsy. Repetitive identical behavioural seizures suggest one onset area, but epileptogenesis might be distributed and connected by functional and structural brain networks outside the seizure onset area, which could explain poor postsurgical outcomes in some patients. Similar networks are postulated in neuropsychiatric disorders, such as depression and anxiety, and seem to overlap with posited epilepsy networks, perhaps explaining the high prevalence of comorbid neuropsychiatric disorders in patients with epilepsy. These networks are difficult to verify with available electrophysiological recording approaches. Advances in intracranial technology are needed to confirm the epilepsy network hypothesis and improve surgical outcomes by providing individualised therapies based on specific network contributions.
颅内电生理记录在耐药性局灶性癫痫患者中是定义致痫性组织的金标准。虽然颅内电生理学、结构磁共振成像和病理学的一致性可以确定切除的脑区，但并非所有局灶性癫痫患者在手术后都能完全控制发作。重复相同的行为性发作提示一个起始区域，但癫痫发作可能通过发作起始区外的功能和结构脑网络分布和连接，这可以解释为什么一些患者手术后效果不佳。类似的网络在神经精神疾病中被假设，如抑郁和焦虑，并且似乎与假设的癫痫网络重叠，也许可以解释癫痫患者中神经精神疾病共病的高患病率。这些网络很难通过现有的电生理记录方法来验证。需要颅内技术的进步来证实癫痫网络假说，并通过提供基于特定网络贡献的个体化治疗来改善手术结果。
