Sonoda Masaki, Carlson Alanna, Rothermel Robert, Kuroda Naoto, Iwaki Hirotaka, Luat Aimee F, Sood Sandeep, Asano Eishi
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, Yokohama City University, Yokohama, Kanagawa 2360004, Japan.
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Psychiatry, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
Epilepsy Behav. 2021 Oct 27;124:108363. doi: 10.1016/j.yebeh.2021.108363.
This retrospective cohort study investigated 53 patients with drug-resistant focal epilepsy and identified factors predictive of long-term satisfaction of patients and families following extraoperative intracranial EEG (iEEG) recording. The mixed model analysis assessed the utility of intracranial EEG (iEEG) predictor variables, including the seizure-onset zone (SOZ), modulation index (MI), and naming-related high-gamma activity. Modulation index, quantifying the coupling between high-frequency activity at >80 Hz and local slow wave at 3-4 Hz, effectively functions as a surrogate marker of the burden of interictal spike-and-slow-wave discharges. The mixed model specifically incorporated 'subtraction-MI', defined as the subtraction of mean z-score normalized MI across all preserved sites from that across all resected sites. Auditory naming-related high-gamma activity at 70-110 Hz is a biomarker to characterize the underlying language and speech function. The model incorporated 'maximum resected high-gamma', defined as the high-gamma percent change largest among sites included in the resected language-dominant hemispheric region. The model also incorporated the clinical and imaging profiles of given patients. The analysis revealed that complete removal of SOZ (p = 0.003) and younger patient age (p = 0.040) were independently associated with greater satisfaction. Neither 'subtraction-MI' nor 'maximum naming-related high-gamma' showed a significant and independent association with long-term satisfaction in our patient cohort. The observed impact of complete resection of SOZ and early surgery can be considered when counseling candidates for epilepsy surgery.
这项回顾性队列研究调查了53例耐药性局灶性癫痫患者，并确定了预测患者及其家属在术中颅内脑电图（iEEG）记录后长期满意度的因素。混合模型分析评估了颅内脑电图（iEEG）预测变量的效用，包括癫痫发作起始区（SOZ）、调制指数（MI）和命名相关的高频伽马活动。调制指数量化了>80Hz的高频活动与3-4Hz的局部慢波之间的耦合，有效地作为发作间期棘波和慢波放电负担的替代标志物。混合模型特别纳入了“减法-MI”，定义为从所有切除部位的平均z分数标准化MI中减去所有保留部位的平均z分数标准化MI。70-110Hz的听觉命名相关高频伽马活动是表征潜在语言和言语功能的生物标志物。该模型纳入了“最大切除高频伽马”，定义为切除的语言优势半球区域内各部位中高频伽马百分比变化最大的部位。该模型还纳入了特定患者的临床和影像学特征。分析显示，SOZ的完全切除（p = 0.003）和患者年龄较小（p = 0.040）与更高的满意度独立相关。在我们的患者队列中，“减法-MI”和“最大命名相关高频伽马”均未显示与长期满意度有显著的独立关联。在为癫痫手术候选人提供咨询时，可以考虑观察到的SOZ完全切除和早期手术的影响。
