Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Epilepsia. 2019 Dec;60(12):2477-2485. doi: 10.1111/epi.16383. Epub 2019 Nov 21.
To evaluate the localization value and prognostic significance of subclinical seizures (SCSs) on scalp video-electroencephalography monitoring (VEEG) in comparison to clinical seizures (CSs) in patients who had epilepsy surgery.
We included 123 consecutive patients who had SCSs and CSs during scalp-VEEG evaluation. All patients had subsequent epilepsy surgery and at least 1-year follow-up. Concordance between SCSs and CSs was summarized into five categories: complete, partial, overlapping, no concordance, or indeterminate. Using the same scheme, we analyzed the relationship between resection and SCS/CS localizations. The concordance measures, along with demographic, electroclinical, and other presurgical evaluation data, were evaluated for their associations with postoperative seizure outcome.
Sixty-nine patients (56.1%) had seizure-free outcome at 1-year follow-up. In 68 patients (55.3%), the localizations of SCSs and CSs were completely concordant. Multivariate logistic analysis showed that complete SCS/CS concordance was independently associated with seizure-free outcome at 1-year (P = .020) and 2-year follow-up (P = .040). In the temporal lobe epilepsy (TLE) seizure-free group, SCS localization was completely contained within the resection in 44.4% and CS localization was completely contained within the resection in 41.7%; in the extratemporal lobe epilepsy (ETLE) seizure-free group, SCS localization was completely contained within the resection in 54.5% and CS localization was completely contained within the resection in 57.6%.
Complete concordance between CS and SCS localization is a positive prognostic factor for 1-year and 2-year postoperative seizure-free outcome. Localization value of SCSs on scalp VEEG is similar to that of CSs for TLE and ETLE. Although SCSs cannot replace CSs, localization information from SCSs should not be ignored.
评估头皮视频脑电图监测（VEEG）中亚临床发作（SCSs）的定位价值和预后意义，并与癫痫手术患者的临床发作（CSs）进行比较。
我们纳入了 123 例在头皮-VEEG 评估期间出现 SCSs 和 CSs 的连续患者。所有患者均接受了后续的癫痫手术，并进行了至少 1 年的随访。将 SCSs 和 CSs 的一致性总结为五个类别：完全一致、部分一致、重叠、无一致性或不确定。我们使用相同的方案分析了切除与 SCS/CS 定位之间的关系。评估一致性测量值以及人口统计学、电临床和其他术前评估数据，以确定它们与术后发作结果的关系。
69 例（56.1%）患者在 1 年随访时无发作。在 68 例（55.3%）患者中，SCSs 和 CSs 的定位完全一致。多变量逻辑分析显示，完全一致的 SCS/CS 一致性与 1 年（P=.020）和 2 年（P=.040）随访时的无发作结果独立相关。在颞叶癫痫（TLE）无发作组中，SCS 定位完全包含在切除范围内的比例为 44.4%，CS 定位完全包含在切除范围内的比例为 41.7%；在外周颞叶癫痫（ETLE）无发作组中，SCS 定位完全包含在切除范围内的比例为 54.5%，CS 定位完全包含在切除范围内的比例为 57.6%。
CS 和 SCS 定位完全一致是术后 1 年和 2 年无发作的积极预后因素。SCS 在头皮 VEEG 上的定位价值与 TLE 和 ETLE 的 CS 定位价值相似。尽管 SCS 不能替代 CS，但不应忽视 SCS 的定位信息。
