Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
Can J Neurol Sci. 2019 Sep;46(5):559-565. doi: 10.1017/cjn.2019.241.
Focal cortical dysplasia (FCD) is a common cause of refractory, focal onset epilepsy in children. Interictal, scalp electroencephalograph (EEG) markers have been associated with these pathologies and epilepsy surgery may be an option for some patients. We aim to study how scalp EEG and magnetic resonance imaging (MRI) markers of FCD affect referral of these patients for surgical evaluation.
A single-center, retrospective review of children with focal onset epilepsy. Patients were included if they were between 1 month and 18 years of age, had focal onset seizures, prolonged scalp EEG monitoring, and an MRI conducted after 2 years of age. Statistics were carried out using the chi-squared and student's t-test, as well as a logistic regression model.
Sixty-eight patients were included in the study. Thirty-seven of these patients were referred to a comprehensive pediatric epilepsy program (CPEP) for surgical evaluation, and of these 22% showed FCD EEG markers, 32% FCD MRI markers, and 10% had both. These markers were also present in patients not referred to a CPEP. The MRI markers were significantly associated with CPEP referral, whereas EEG markers were not. Neither marker type was associated with epilepsy surgery.
This study found that children with focal onset epilepsy were more likely to be referred for surgical evaluation if they were medically refractory, or were diagnosed with FCD or tumor on MRI. Scalp EEG markers of FCD were not associated with CPEP referral. The online tool CASES may be a useful physician guide for identifying appropriate children for epilepsy surgery referral.
局灶性皮质发育不良（FCD）是儿童难治性局灶性癫痫的常见病因。发作间期头皮脑电图（EEG）标志物与这些病变有关，手术治疗可能是一些患者的选择。我们旨在研究 FCD 的头皮 EEG 和磁共振成像（MRI）标志物如何影响这些患者接受手术评估的转介。
对患有局灶性癫痫发作的儿童进行单中心回顾性研究。纳入标准为年龄在 1 个月至 18 岁之间、有局灶性发作性癫痫、进行了长时间的头皮 EEG 监测、且在 2 岁后进行了 MRI。使用卡方检验和学生 t 检验以及逻辑回归模型进行统计学分析。
本研究共纳入 68 例患者。其中 37 例患者被转介至综合儿科癫痫计划（CPEP）进行手术评估，其中 22%的患者存在 FCD EEG 标志物，32%的患者存在 FCD MRI 标志物，10%的患者存在两者。这些标志物在未被转介至 CPEP 的患者中也存在。MRI 标志物与 CPEP 转介显著相关，而 EEG 标志物则不然。两种标志物类型均与癫痫手术无关。
本研究发现，对于药物难治性癫痫或 MRI 诊断为 FCD 或肿瘤的儿童，更有可能被转介进行手术评估。FCD 的头皮 EEG 标志物与 CPEP 转介无关。在线工具 CASES 可能是一种有用的医生指南，用于识别适合癫痫手术转介的儿童。
