Department of Neurology, George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A.
J Clin Neurophysiol. 2020 Jul;37(4):306-309. doi: 10.1097/WNP.0000000000000684.
Eliminating or reducing seizures is a main goal of epilepsy treatment, and clinicians rely mainly on patient self-report regarding seizure frequency. Here, we compare seizure frequency by patient report with responsive neurostimulation (RNS) recordings in two patients, one of whom also had prolonged scalp EEG recording. RNS being more sensitive in detecting seizures than scalp EEG, our cases illustrate that patients may strikingly underreport seizure frequency. In addition, patients may also overreport seizures. Although a negative scalp EEG study does not exclude the possibility of focal aware seizures, RNS can reliably differentiate between nonepileptic events and focal aware seizures if electrodes are properly placed in the seizure-onset zone. Besides its therapeutic benefit, RNS can also play an important role in identifying seizure frequency. Improving seizure monitoring using the device could help to optimize therapy and outcome.
消除或减少癫痫发作是癫痫治疗的主要目标，临床医生主要依赖患者自身报告的发作频率。在这里，我们比较了两位患者的发作频率，其中一位患者还进行了长时间的头皮脑电图记录，通过患者报告和反应性神经刺激（RNS）记录的结果。由于 RNS 比头皮 EEG 更能敏感地检测到癫痫发作，我们的病例表明，患者可能会显著低估发作频率。此外，患者也可能会高估发作频率。尽管头皮 EEG 研究阴性并不能排除局灶性意识性癫痫发作的可能性，但如果将电极正确放置在发作起始区，RNS 可以可靠地区分非癫痫性事件和局灶性意识性癫痫发作。除了治疗益处外，RNS 还可以在确定发作频率方面发挥重要作用。使用该设备改善癫痫监测可以帮助优化治疗效果。
