Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany.
LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
Epilepsia. 2019 Jul;60(7):1353-1364. doi: 10.1111/epi.16052. Epub 2019 Jun 6.
Focal edema of the splenium of the corpus callosum (FESCC) is infrequently seen in patients with epilepsy who are undergoing video-electroencephalography (EEG) monitoring. It is diagnosed by qualitative visual inspection of the magnetic resonance imaging (MRI) and is usually assumed to be a dichotomous phenomenon. Rapid reduction of anticonvulsants has been proposed as a cause. In this study we investigate the relationship between dose reduction of anticonvulsants and the occurrence of FESCC, based on absolute drug doses.
We examined in detail the anticonvulsive therapy of all patients during video-EEG monitoring between 2014 and 2018. We compared patients with a radiologically diagnosed FESCC to controls in a 1:2 case-control analysis matched by age, epilepsy syndrome, and adjacent time of admission. In a separate correlation analysis, we examined quantitative effects of reduction of antiseizure drugs on diffusion restriction in the corpus callosum.
Of 326 patients who had an MRI following video-EEG monitoring, 12 (3.7%) had FESCC. Antiseizure drugs were reduced to a significantly greater extent in FESCC patients than in the 24 controls (P < 0.001). Sodium channel-blocking antiseizure drugs were reduced (P < 0.001) and reintroduced (P < 0.001) significantly faster in FESCC patients, and the duration of anticonvulsant discontinuation was longer in FESCC patients (P < 0.001). The separate correlation analysis in 325 patients shows a weak correlation between diffusion restriction in the splenium and the reduction rate of sodium channel-blocking anticonvulsants (r = -0.15, P = 0.03) as well as the duration of their discontinuation (r = -0.16, P = 0.01). No such effects were found for anticonvulsants with other modes of action.
Our findings substantiate that FESCC is associated with high rates of dose reduction of anticonvulsants, specifically those acting on sodium channels. Our results cautiously suggest that reducing sodium-channel blockers has a small effect on diffusivity in the splenium below the visual threshold.
胼胝体压部局灶性水肿（FESCC）在接受视频脑电图（EEG）监测的癫痫患者中并不常见。它通过磁共振成像（MRI）的定性视觉检查进行诊断，通常被认为是一种二分现象。已经提出快速减少抗惊厥药物作为其原因。在这项研究中，我们根据绝对药物剂量，研究了抗惊厥药物剂量减少与 FESCC 发生之间的关系。
我们详细检查了 2014 年至 2018 年间在视频-EEG 监测期间所有患者的抗惊厥治疗。我们将影像学诊断为 FESCC 的患者与年龄、癫痫综合征和入院相邻时间相匹配的 2:1 病例对照分析中的对照组进行比较。在单独的相关分析中，我们检查了抗癫痫药物减少对胼胝体弥散受限的定量影响。
在接受视频-EEG 监测后进行 MRI 的 326 名患者中，有 12 名（3.7%）出现 FESCC。FESCC 患者的抗惊厥药物减少幅度明显大于 24 名对照组（P<0.001）。FESCC 患者的钠通道阻断抗惊厥药物减少（P<0.001）和重新引入（P<0.001）速度明显更快，FESCC 患者的抗惊厥药物停药时间更长（P<0.001）。在 325 名患者的单独相关分析中，显示在胼胝体压部的弥散受限与钠通道阻断性抗惊厥药物的减少率（r=-0.15，P=0.03）以及其停药时间（r=-0.16，P=0.01）之间存在弱相关性。对于具有其他作用模式的抗惊厥药物，未发现此类影响。
我们的研究结果证实，FESCC 与抗惊厥药物剂量的大量减少有关，特别是那些作用于钠通道的药物。我们的结果谨慎地表明，减少钠通道阻滞剂对视觉阈值以下胼胝体压部的弥散性有较小的影响。
