Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
Childs Nerv Syst. 2021 May;37(5):1429-1437. doi: 10.1007/s00381-021-05069-z. Epub 2021 Feb 18.
Electrical source imaging (ESI) and especially hdEEG represent a noninvasive, low cost and accurate method of localizing epileptic zone (EZ). Such capability can greatly increase seizure freedom rate in surgically treated drug resistant epilepsy cases. Furthermore, ESI might be important in intracranial record planning.
We report the case of a 15 years old boy suffering from drug resistant epilepsy with a previous history of DNET removal. The patient suffered from heterogeneous seizure semiology characterized by anesthesia and loss of tone in the left arm, twisting of the jaw to the left and dysarthria accompanied by daze; lightheadedness sometimes associated with headache and dizziness and at a relatively short time distance negative myoclonus involving the left hand. Clinical evidence poorly match scalp and video EEG monitoring thus requiring hdEEG recording followed by SEEG to define surgical target. Surgery was also guided by ECoG and obtained seizure freedom.
ESI offers an excellent estimate of EZ, being hdEEG and intracranial recordings especially important in defining it. We analyzed our results together with the data from the literature showing how in children hdEEG might be even more crucial than in adults due to the heterogeneity in seizures phenomenology. The complexity of each case and the technical difficulties in dealing with children, stress even more the importance of a noninvasive tool for diagnosis. In fact, hdEEG not only guided in the presented case SEEG planning but may also in the future offer the possibility to replace it.
电源定位（ESI），尤其是高分辨率 EEG（hdEEG），代表了一种非侵入性、低成本和准确的定位癫痫病灶（EZ）的方法。这种能力可以极大地提高手术治疗耐药性癫痫病例的无癫痫发作率。此外，ESI 在颅内记录规划中可能很重要。
我们报告了一例 15 岁男孩患有耐药性癫痫，此前曾行 DNET 切除术。该患者表现出异质性癫痫发作症状，表现为左侧手臂麻醉和张力丧失、下巴向左扭曲和构音障碍，伴有发呆；有时伴有头痛和头晕，并在相对较短的时间距离内出现左侧手部负性肌阵挛。头皮和视频脑电图监测的临床证据匹配不佳，因此需要进行 hdEEG 记录，随后进行 SEEG 以确定手术目标。手术还受到 ECoG 的指导，并获得了无癫痫发作。
ESI 提供了 EZ 的极佳估计，hdEEG 和颅内记录对于其定义尤为重要。我们分析了我们的结果，并结合文献中的数据，显示在儿童中，hdEEG 可能比成人更为重要，因为癫痫发作的表型存在异质性。每个病例的复杂性以及处理儿童的技术困难，更加强调了诊断的非侵入性工具的重要性。事实上，hdEEG 不仅指导了本病例的 SEEG 规划，而且在未来可能还有望取代它。
