Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; New York University Langone Comprehensive Epilepsy Center, New York University, New York, NY, USA.
Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
Clin Neurophysiol. 2020 Aug;131(8):1702-1710. doi: 10.1016/j.clinph.2020.04.019. Epub 2020 May 11.
Postencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG).
We conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex.
Independent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a "patchwork" organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048).
Postencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group.
These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections.
脑炎后癫痫通常对抗癫痫药物有抗性，因此需要评估癫痫手术。确定其定位对最佳手术方法具有重要意义。我们旨在确定在接受立体定向脑电图（SEEG）的耐药性癫痫患者中，是否存在先前的脑炎病史与特定的致痫网络相关。
我们进行了一项回顾性队列研究，研究对象为有或无先前脑炎病史的耐药性癫痫患者。我们分析了 SEEG 记录以确定发作起始和组织的模式。从接受 SEEG 的患者数据库中确定了 17 例有脑炎病史的患者（2 例为感染性病因），并与 17 例无脑炎病史的耐药性癫痫对照患者进行了比较，这些对照患者在植入前假设、癫痫持续时间、年龄和性别等混杂变量方面相匹配。
在脑炎后癫痫组中，65%的患者出现了独立的双侧发作。我们在有先前脑炎病史的患者中发现了四种 SEEG 发作模式：（1）前内侧颞叶起始（24%）；（2）前内侧颞叶起始伴早期向侧脑室区域扩散（29%）；（3）侧脑室区域（59%）和（4）同步的前内侧颞叶和侧脑室区域起始（29%）。模式 3 和 4，即发作起始时累及侧脑室区域，是脑炎组特有的（p=0.0003 和 0.04），表现出“拼凑”的组织。脑炎组中无一例患者的 Engel I 结果优于对照组（p=0.0048）。
脑炎后癫痫涉及前内侧颞叶和侧脑室网络，通常以双侧独立的方式发生。在脑炎组中发现了独特的累及侧脑室区域的发作模式，但在匹配的对照组中没有发现。
这些发现可能反映了侧脑室区域对脑炎后癫痫的选择性易感性，这显著降低了 SEEG 引导的颞叶切除术成功的机会。
