Toledano R, Martínez-Álvarez R, Jiménez-Huete A, García-Morales I, Aledo-Serrano Á, Cabrera W, Rey G, Campo P, Gómez-Angulo J C, Blumcke I, Álvarez-Linera J, Del Pozo J M, Gil-Nagel A
Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España; Programa de Epilepsia, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
Servicio de Neurocirugía Funcional y Radiocirugía, Hospital Ruber Internacional, Madrid, España.
Neurologia (Engl Ed). 2022 Jun;37(5):334-345. doi: 10.1016/j.nrl.2019.05.002. Epub 2019 Jul 20.
Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE.
In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure.
The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages.
SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.
立体定向脑电图（SEEG）是一种用于术前评估难治性局灶性癫痫（DLRFE）患者的技术，有助于研究深部皮质结构。该技术在国际癫痫中心的应用日益广泛，但在西班牙尚未得到充分发展。我们描述了我们在DLRFE术前评估中使用SEEG的经验。
在过去8年中，我们癫痫中心对71例DLRFE患者进行了SEEG评估。我们前瞻性地分析了我们在癫痫灶（EZ）定位、手术结果以及与该手术相关的并发症方面的结果。
样本的中位年龄为30岁（范围4 - 59岁）；27例患者（38%）为女性。45例患者（63.4%）脑部磁共振成像未显示异常。共植入627根电极（中位值，每位患者9根电极；范围1 - 17根），50%的植入为多脑叶植入。64例患者（90.1%）确定了EZ，其中66%的病例EZ位于颞叶外或颞叶加其他区域。61例接受手术的患者中有55例随访超过一年：在随访的最后一年，58.2%的患者无癫痫发作（Engel癫痫手术结果量表I级），76.4%的患者预后良好（Engel I - II级）。3例患者（4.2%）出现脑内出血。
SEEG能够在以前无法做到的情况下对EZ进行定位，与其他侵入性技术相比，手术效果更好，且并发症发生率相对较低。
