Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Epilepsy Behav. 2020 Nov;112:107468. doi: 10.1016/j.yebeh.2020.107468. Epub 2020 Sep 23.
Repeated routine electroencephalography (EEG) or even long-term video-EEG monitoring (VEM) does not always record interictal epileptiform discharges (IEDs) in some patients with epilepsy. The present study investigated whether focal seizures detected by VEM and focal abnormalities on neuroimaging are useful for the diagnosis of patients with focal epilepsy without IEDs.
We retrospectively reviewed 409 consecutive patients with focal epilepsy (207 men, aged 9 to 76 years) who underwent 4- or 5-day VEM, magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis to identify patients without IEDs. The occurrence of focal seizures during VEM and the presence of focal abnormalities on neuroimaging were investigated in those patients. The occurrence rate of seizures during VEM was investigated in patients with daily, weekly, monthly, and yearly seizure frequency based on history-taking.
Ninety-five (23.2%) of 409 patients with focal epilepsy did not have IEDs. Fifty-five (57.9%) of the 95 patients had focal seizures during VEM. Fifty-four patients (56.8%) showed focal abnormalities compatible with seizure semiology on neuroimaging investigations. Neither seizure recordings nor neuroimaging abnormalities were seen in 16 (16.8%) of the 95 patients. The occurrence rate of seizures during VEM depended on the seizure frequency at history-taking. However, 28 (45.9%) of 61 patients with monthly and yearly seizure frequency had focal seizures during 4- or 5-day VEM with seizure induction.
Video-EEG monitoring can detect focal seizures in patients with focal epilepsy but no IEDs. Comprehensive assessment including VEM and neuroimaging study is important for the diagnosis.
在一些癫痫患者中，重复进行常规脑电图（EEG）甚至长时间视频脑电图监测（VEM）并不总能记录到发作间期癫痫样放电（IEDs）。本研究旨在探讨通过 VEM 检测到局灶性发作和神经影像学上的局灶性异常是否有助于诊断无 IED 的局灶性癫痫患者。
我们回顾性分析了 409 例连续的局灶性癫痫患者（207 例男性，年龄 9 至 76 岁），这些患者接受了 4 或 5 天的 VEM、磁共振成像（MRI）和氟-18-氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）检查以明确诊断，以确定无 IED 的患者。对这些患者进行了 VEM 期间局灶性发作的发生情况和神经影像学上局灶性异常的研究。根据病史记录，对每日、每周、每月和每年发作频率的患者进行了 VEM 期间发作的发生率研究。
409 例局灶性癫痫患者中，95 例（23.2%）无 IEDs。95 例患者中，55 例（57.9%）在 VEM 期间出现局灶性发作。54 例（56.8%）患者的神经影像学检查显示与发作症状学一致的局灶性异常。在 95 例患者中，有 16 例（16.8%）既没有癫痫发作记录，也没有神经影像学异常。VEM 期间发作的发生率取决于病史记录时的发作频率。然而，61 例每月和每年发作频率的患者中，有 28 例（45.9%）在 4 或 5 天的 VEM 中有局灶性发作并进行了癫痫诱导。
VEM 可检测到无 IED 的局灶性癫痫患者的局灶性发作。包括 VEM 和神经影像学研究在内的综合评估对于诊断很重要。
