Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Acta Neurochir (Wien). 2022 Feb;164(2):555-563. doi: 10.1007/s00701-022-05122-z. Epub 2022 Jan 18.
OBJECTIVE: The aim of this study was to investigate the different ictal onset stereoelectroencephalography patterns (IOPs) in patients with drug-resistant temporal lobe epilepsy (TLE). We examined whether the IOPs relate to different TLE subtypes, MRI findings, and underlying pathologies, and we evaluated their prognostic value for predicting the surgical outcome. METHODS: We retrospectively analyzed data from patients with TLE who underwent stereoelectroencephalography (SEEG) monitoring followed by surgical resection between January 2018 and January 2020. The SEEG recordings were independently analyzed by two epileptologists. RESULTS: Forty-five patients were included in the study, and 61seizures were analyzed. Five IOPs were identified: low voltage fast activity (LVFA; 44.3%), spike-and-wave activity (16.4%), low frequency high-amplitude periodic spikes (LFPS; 18%), a burst of high-amplitude polyspikes (8.2%), and rhythmic sharp activity at ≤ 13 Hz (13.1%). Thirty-two patients were found to have a single IOP, while the other 13 patients had two or more IOPs. All five IOPs were found to occur in the medial temporal lobe epilepsy (MTLE), while four IOPs occurred in the lateral temporal lobe epilepsy (LTLE). The LFPS was a common IOP that could distinguish MTLE from LTLE (x = 7.046, p = 0.011). Among the MTLE patients, the LFPS was exclusively seen in cases of hippocampal sclerosis (x = 5.058, p = 0.038), while the LVFA was associated with nonspecific histology (x = 6.077, p = 0.023). The IOPs were not found to differ according to whether the MRI scans were positive or negative. After surgery, patients achieved the higher seizure-free rate at 81.8% and 77.8%, respectively, if the LFPS and LVFA were the predominant patterns. Multiple IOPs or a negative MRI did not indicate a poor prognosis. CONCLUSIONS: Five distinct IOPs were identified in the patients with TLE. The differences found have important clinical implications and could provide complementary information for surgical decision-making, especially in MRI-negative patients.
目的：本研究旨在探讨耐药性颞叶癫痫（TLE）患者不同的发作起始立体脑电图（SEEG）模式（IOP）。我们研究了这些 IOP 是否与不同的 TLE 亚型、MRI 发现和潜在病理学相关，并评估了它们对预测手术结果的预后价值。
方法：我们回顾性分析了 2018 年 1 月至 2020 年 1 月间接受立体脑电图（SEEG）监测和手术切除的 TLE 患者的数据。SEEG 记录由两名癫痫专家独立分析。
结果：共纳入 45 例患者，分析了 61 次发作。共发现 5 种 IOP：低电压快活动（LVFA；44.3%）、棘波和尖波活动（16.4%）、低频高振幅周期性棘波（LFPS；18%）、高振幅多棘波爆发（8.2%）和≤13 Hz 的节律性锐波（13.1%）。32 例患者表现为单一 IOP，13 例患者存在两种或更多种 IOP。所有 5 种 IOP 均发生在内侧颞叶癫痫（MTLE）中，4 种 IOP 发生在外侧颞叶癫痫（LTLE）中。LFPS 是一种常见的 IOP，可将 MTLE 与 LTLE 区分开（x=7.046，p=0.011）。在 MTLE 患者中，LFPS 仅见于海马硬化病例（x=5.058，p=0.038），而 LVFA 与非特异性组织学相关（x=6.077，p=0.023）。MRI 扫描阳性或阴性的患者之间，IOP 无差异。术后，LFPS 和 LVFA 为主导模式时，患者的无癫痫发作率分别为 81.8%和 77.8%。存在多种 IOP 或 MRI 阴性并不提示预后不良。
结论：在 TLE 患者中发现了 5 种不同的 IOP。这些差异具有重要的临床意义，可为手术决策提供补充信息，特别是在 MRI 阴性患者中。
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