Department of Neurology, Icahn School of Medicine at Mount Sinai Downtown, New York, New York, U.S.A.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.; and.
J Clin Neurophysiol. 2023 Nov 1;40(7):574-581. doi: 10.1097/WNP.0000000000000936. Epub 2022 Mar 16.
To describe the relationship of electrocorticography events detected by a brain-responsive neurostimulation system (RNS) and their association with ictal and interictal activity detected on simultaneous scalp EEG.
We retrospectively identified patients with drug-resistant epilepsy implanted with RNS who subsequently underwent long-term scalp EEG monitoring. RNS detections were correlated to simultaneous activity recorded on scalp EEG to determine the characteristics of electrocorticography-stored long episodes associated with seizures or other findings on scalp EEG.
Eleven patients were included with an average of 3.6 days of monitoring. Most RNS detections were of very brief duration (<10 seconds, 92.9%) and received one stimulation therapy (80.8%). A high proportion of long episodes (67.1%) were not identified as electrographic seizures on scalp EEG. Of those ictal-appearing (71.2%) long episodes, 68.2% had seizure correlates. Long episodes associated with seizures on scalp EEG had a longer median duration compared with those without (39.7 vs. 16.8 seconds, P < 0.002) and had broader spread pattern and were of higher amplitude on electrocorticography. Brief potentially ictal rhythmic discharges were the most common EEG findings associated with long episodes that did not have scalp EEG seizure correlates (100% for ictal- and 50% for non-ictal-appearing long episodes).
Longer, broader spread and higher amplitude intracranial RNS detections are more likely to manifest as electrographic seizures on scalp EEG. Brief potentially ictal rhythmic discharges may serve as a scalp EEG biomarker of ictal intracranial episodes that are detected as long episodes by the RNS but not identified as electrographic seizures on scalp EEG.
描述脑反应性神经刺激系统（RNS）检测到的电皮质描记术事件与同时头皮 EEG 检测到的发作期和发作间期活动之间的关系。
我们回顾性地确定了植入 RNS 且随后接受长期头皮 EEG 监测的耐药性癫痫患者。将 RNS 检测与头皮 EEG 上同时记录的活动相关联，以确定与癫痫发作或头皮 EEG 上其他发现相关的电皮质描记术长发作的特征。
共纳入 11 例患者，平均监测时间为 3.6 天。大多数 RNS 检测持续时间非常短暂（<10 秒，92.9%），并接受了一次刺激治疗（80.8%）。很大一部分长发作（67.1%）在头皮 EEG 上未被识别为电描记术发作。在那些表现为发作期的长发作中（71.2%），68.2%有癫痫发作相关。与头皮 EEG 上癫痫发作相关的长发作的中位持续时间长于无癫痫发作的长发作（39.7 与 16.8 秒，P<0.002），并且在电皮质描记术上具有更广泛的传播模式和更高的振幅。短暂的潜在发作性节律性放电是与无头皮 EEG 癫痫发作相关的长发作最常见的 EEG 发现（100%的发作期和 50%的非发作期）。
较长、较广泛传播和较高振幅的颅内 RNS 检测更有可能在头皮 EEG 上表现为电描记术发作。短暂的潜在发作性节律性放电可能是 RNS 检测到的长发作但在头皮 EEG 上未被识别为电描记术发作的发作期颅内事件的头皮 EEG 生物标志物。
