前瞻性观察研究：快棘波定位有助于致痫灶的定位。
Prospective observational study: Fast ripple localization delineates the epileptogenic zone.
机构信息
Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA.
Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA.
出版信息
Clin Neurophysiol. 2019 Nov;130(11):2144-2152. doi: 10.1016/j.clinph.2019.08.026. Epub 2019 Sep 17.
OBJECTIVE
To investigate spatial correlation between interictal HFOs and neuroimaging abnormalities, and to determine if complete removal of prospectively identified interictal HFOs correlates with post-surgical seizure-freedom.
METHODS
Interictal fast ripples (FRs: 250-500 Hz) in 19 consecutive children with pharmacoresistant focal epilepsy who underwent extra-operative electrocorticography (ECoG) recording were prospectively analyzed. The interictal FRs were sampled at 2000 Hz and were visually identified during 10 min of slow wave sleep. Interictal FRs, MRI and FDG-PET were delineated on patient-specific reconstructed three-dimensional brain MRI.
RESULTS
Interictal FRs were observed in all patients except one. Thirteen out of 18 patients (72%) exhibited FRs beyond the extent of neuroimaging abnormalities. Fifteen of 19 children underwent resective surgery, and survival analysis with log-rank test demonstrated that complete resection of cortical sites showing interictal FRs correlated with longer post-operative seizure-freedom (p < 0.01). Complete resection of seizure onset zones (SOZ) also correlated with longer post-operative seizure-freedom (p = 0.01), yet complete resection of neuroimaging abnormalities did not (p = 0.43).
CONCLUSIONS
Prospective visual analysis of interictal FRs was feasible, and it seemed to accurately localize epileptogenic zones.
SIGNIFICANCE
Topological extent of epileptogenic region may exceed what is discernible by multimodal neuroimaging.
目的
研究发作间期高频振荡（HFOs）与神经影像学异常之间的空间相关性，并确定是否完全切除前瞻性识别的发作间期 HFOs 与术后无癫痫发作有关。
方法
对 19 例药物难治性局灶性癫痫患者进行了手术前皮层脑电图（ECoG）记录，对其进行了前瞻性分析。发作间期快涟漪（FR：250-500 Hz）在 19 例连续患者中进行了前瞻性分析。在 10 分钟的慢波睡眠中，以 2000 Hz 的速度对发作间期 FRs 进行采样，并在视觉上进行识别。发作间期 FRs、MRI 和 FDG-PET 在患者特定的三维脑 MRI 上进行了描绘。
结果
除 1 例患者外，所有患者均观察到发作间期 FRs。18 例患者中有 13 例（72%）的 FRs 超出了神经影像学异常的范围。19 例儿童中有 15 例接受了切除术，对数秩检验的生存分析表明，皮质部位的发作间期 FRs 完全切除与术后更长时间的无癫痫发作相关（p < 0.01）。发作起始区（SOZ）的完全切除也与术后更长时间的无癫痫发作相关（p = 0.01），但神经影像学异常的完全切除没有（p = 0.43）。
结论
前瞻性视觉分析发作间期 FRs 是可行的，它似乎可以准确地定位致痫区。
意义
癫痫区域的拓扑范围可能超过多模态神经影像学所能识别的范围。
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