APHM, Timone Hospital, Epileptology Department, Marseille, France.
Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France; APHM, Timone Hospital, Epileptology Department, Marseille, France.
Epilepsy Behav. 2020 Nov;112:107436. doi: 10.1016/j.yebeh.2020.107436. Epub 2020 Sep 6.
Frontal seizures are organized according to anatomo-functional subdivisions of the frontal lobe. Prefrontal seizures have been the subject of few detailed studies to date. The objective of this study was to identify subcategories of prefrontal seizures based on seizure onset quantification and to look for semiological differences.
Consecutive patients who underwent stereoelectroencephalography (SEEG) for drug-resistant prefrontal epilepsy between 2000 and 2018 were included. The different prefrontal regions investigated in our patients were dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), dorsomedial prefrontal cortex (DMPFC), ventromedial prefrontal cortex (VMPFC), and orbitofrontal cortex (OFC). The seizure onset zone (SOZ) was determined from one or two seizures in each patient, using the epileptogenicity index (EI) method. The presence or absence of 16 clinical ictal manifestations was analyzed. Classification of prefrontal networks was performed using the k-means automatic classification method.
A total of 51 seizures from 31 patients were analyzed. The optimal clustering was 4 subgroups of prefrontal seizures: a "pure DLPF" group, a "pure VMPF" group, a "pure OFC" group, and a "global prefrontal" group. The first 3 groups showed a mean EI considered epileptogenic (>0.4) only in one predominant structure, while the fourth group showed a high mean EI in almost all prefrontal structures. The median number of epileptogenic structures per seizure (prefrontal or extrafrontal) was 5 for the "global prefrontal" group and 2 for the other groups. We found that the most common signs were altered consciousness, automatisms/stereotypies, integrated gestural motor behavior, and hyperkinetic motor behavior. We found no significant difference in the distribution of ictal signs between the different groups.
Our study showed that although most prefrontal seizures manifest as a network of several anatomically distinct structures, we were able to determine a sublobar organization of prefrontal seizure onset with four groups.
额部癫痫是根据额叶的解剖功能进行分类的。迄今为止，针对前额叶癫痫发作，已有少数详细研究。本研究的目的是根据发作起始量化确定前额叶发作的亚类，并寻找半定性差异。
本研究纳入了 2000 年至 2018 年间因药物难治性前额叶癫痫行立体脑电图（SEEG）检查的连续患者。我们的患者中研究的不同前额叶区域包括背外侧前额叶皮层（DLPFC）、腹外侧前额叶皮层（VLPFC）、背内侧前额叶皮层（DMPFC）、腹内侧前额叶皮层（VMPFC）和眶额皮层（OFC）。使用致痫性指数（EI）方法，从每位患者的一次或两次发作中确定发作起始区（SOZ）。分析了 16 种临床发作表现的存在或缺失。使用 k-均值自动分类方法对前额叶网络进行分类。
共分析了 31 名患者的 51 次发作。最佳聚类为 4 组前额叶癫痫发作：“单纯 DLPF”组、“单纯 VMPF”组、“单纯 OFC”组和“全前额叶”组。前 3 组的平均 EI（>0.4）仅在一个主要结构中被认为具有致痫性，而第 4 组在几乎所有前额叶结构中的平均 EI 较高。每组每发作（前额叶或前额叶外）的致痫性结构中位数为 5 个，而其他组为 2 个。我们发现最常见的征象是意识改变、自动症/刻板症、整合运动行为和多动运动行为。我们发现不同组之间的发作征象分布没有显著差异。
我们的研究表明，尽管大多数前额叶癫痫发作表现为几个解剖上不同结构的网络，但我们能够确定 4 个组的前额叶发作起始亚区组织。
