皮质发育不良的小儿癫痫手术队列的发作起始的时空分布和年龄。

Spatiotemporal distribution and age of seizure onset in a pediatric epilepsy surgery cohort with cortical dysplasia.

机构信息

Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA.

Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington DC, USA; Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rungsit University, Bangkok, Thailand.

出版信息

Epilepsy Res. 2021 May;172:106598. doi: 10.1016/j.eplepsyres.2021.106598. Epub 2021 Mar 2.

DOI:10.1016/j.eplepsyres.2021.106598

PMID:33711709

Abstract

OBJECTIVE

Focal Cortical Dysplasias (CD) are a common etiology of refractory pediatric epilepsy and are amenable to epilepsy surgery. We investigated the association of lesion volume and location to age of seizure onset among children with CD who underwent epilepsy surgery.

METHODS

A retrospective study of epilepsy surgery patients with pathologically-confirmed CD. Regions of interest (ROI) determined preoperative lesion volumes on 1.5 T and 3 T T2 and SPGR MRIs, and location in 7 distributed neural networks. Descriptive and inferential statistics were used.

RESULTS

Fifty-five patients were identified: 35 girls (56.5 %). Median age of seizure onset: 19.0 months (range 0.02 months - 16.0 years). Median age of surgery: 7.8 years (range 2.89 months - 24.45 years). CD were frontal (n = 21, 38 %); temporal (n = 15, 27 %); parietal (n = 10, 18 %); occipital (n = 3, 5%); multilobar (n = 6, 11 %). Frontal FCD had seizure onset < 1-year-old (P = 0.10); temporal lobe CD seizure onset was more likely > 5-years-old (P= 0.06). Median lesion volume for CD was 23.23 cm (range: 1.87-591.73 cm). Larger CD lesions were associated with earlier epilepsy (P = 0.01, r = -0.16). We did not find that lesions proximal to early maturing cortical regions were associated with earlier seizure onset. We found an association with CD location in the default mode network (DMN) and age onset < 5years old (P = 0.03). Age of seizure onset was negatively correlated with percent of CD overlapping motor cortex (P = 0.001, r =-0.794) but not with CD overlap of the visual cortex (P = 0.35). There was no effect of CD type on age of epilepsy onset.

SIGNIFICANCE

Larger CD lesions are associated with earlier onset epilepsy. CD most commonly occurs within the DMN and Limbic network, and DMN is associated with seizure onset before 5-years-old. Percent of CD overlapping motor cortex correlates with earlier seizure onset. These observations may reflect patterns of brain maturation or regional differences in clinical expression of seizures.

摘要

目的

局灶性皮质发育不良（CD）是儿童难治性癫痫的常见病因，且适合癫痫手术治疗。本研究旨在探讨 CD 患儿癫痫发作的发病年龄与病灶体积和位置的关系。

方法

对经病理证实的 CD 患者进行回顾性研究。术前在 1.5T 和 3T T2 和 SPGR MRI 上确定感兴趣区域（ROI）以确定病灶体积，病灶位置分布在 7 个神经网络中。采用描述性和推断性统计分析。

结果

共纳入 55 例患者，其中女 35 例（56.5%）。癫痫发作的中位年龄为 19.0 个月（范围 0.02-16.0 年）。手术的中位年龄为 7.8 岁（范围 2.89-24.45 岁）。CD 病变位于额叶（21 例，38%）、颞叶（15 例，27%）、顶叶（10 例，18%）、枕叶（3 例，5%）、多脑叶（6 例，11%）。额叶 FCD 的发病年龄<1 岁（P=0.10）；颞叶 CD 发病年龄更可能>5 岁（P=0.06）。CD 的中位病灶体积为 23.23cm³（范围：1.87-591.73cm³）。较大的 CD 病变与癫痫发病年龄较早相关（P=0.01，r=-0.16）。我们没有发现病灶位置靠近早期成熟皮质区域与发病年龄较早有关。我们发现 CD 位于默认模式网络（DMN）与发病年龄<5 岁之间存在关联（P=0.03）。癫痫发作的发病年龄与 CD 重叠运动皮质的百分比呈负相关（P=0.001，r=-0.794），但与 CD 重叠视觉皮质无关（P=0.35）。CD 类型对癫痫发病年龄无影响。