Kanai Sotaro, Okanishi Tohru, Nishimura Mitsuyo, Oguri Masayoshi, Enoki Hideo, Maegaki Yoshihiro, Fujimoto Ayataka
Division of Child Neurology, Faculty of Medicine, Institute of Neurological Sciences, Tottori University, Yonago, Japan.
Department of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan.
Front Neurol. 2020 Apr 2;11:232. doi: 10.3389/fneur.2020.00232. eCollection 2020.
Corpus callosotomy (CC) is the surgical strategy for drug-resistant epileptic seizures including epileptic spasms (ES). In this study we report a subtype of ES which is accompanied by two consecutive muscular contractions. This subtype has not been previously classified and may emerge via a complex epileptic network. We named these seizures "epileptic spasms with biphasic muscular contractions (ES-BMC)" and analyzed the association between them and CC outcomes. We enrolled 17 patients with ES who underwent CC before 20 years of age, and analyzed the records of long-term video-electroencephalogram (EEG) recordings. The outcomes of CC were ES-free (Engel's classification I) in 7 and residual ES (II to IV) in 10 patients. We statistically analyzed the associations between the presence of preoperative ES-BMC and the outcomes. Ages at CC ranged from 17 to 237 months. We analyzed 4-44 ictal EEGs for each patient. Five patients presented with ES-BMC with 6-40% of their whole ES on the presurgical video-EEG recordings, and all of them exhibited residual ES outcomes following CC. A Fisher's exact test revealed a significant positive correlation between the presence of preoperative ES-BMC and persistence of ES following CC ( = 0.044, odds ratio = 15.0, risk ratio = 2.0). The presence of ES-BMC may be useful in the presurgical prediction of CC outcomes in patients with ES.
胼胝体切开术（CC）是治疗包括癫痫性痉挛（ES）在内的耐药性癫痫发作的手术策略。在本研究中，我们报告了一种伴有连续两次肌肉收缩的ES亚型。这种亚型此前未被分类，可能通过复杂的癫痫网络出现。我们将这些发作命名为“伴有双相肌肉收缩的癫痫性痉挛（ES-BMC）”，并分析了它们与CC结果之间的关联。我们纳入了17例20岁之前接受CC的ES患者，并分析了长期视频脑电图（EEG）记录。CC的结果为7例无ES发作（Engel分类I级），10例有残留ES发作（II至IV级）。我们对术前ES-BMC的存在与结果之间的关联进行了统计学分析。CC时的年龄范围为17至237个月。我们为每位患者分析了4至44次发作期EEG。5例患者在术前视频EEG记录中出现ES-BMC，占其全部ES发作的6%至40%，并且所有这些患者在CC后均表现为残留ES发作。Fisher精确检验显示术前ES-BMC的存在与CC后ES发作的持续存在之间存在显著正相关（P = 0.044，优势比 = 15.0，风险比 = 2.0）。ES-BMC的存在可能有助于对ES患者CC结果进行术前预测。
