Department of Neurology Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA.
Clin Neurophysiol. 2022 Jun;138:97-107. doi: 10.1016/j.clinph.2022.02.024. Epub 2022 Mar 15.
To determine EEG spatiospectral activation and connectivity in the generalized tonic-clonic seizure (GTCS) semiological subtypes.
39 patients with genetic generalized epilepsy (GGE) who had GTCS (n = 58) during video-EEG monitoring were identified in the Vanderbilt Epilepsy database. GTCSs were classified as absence tonic-clonic, myoclonic tonic-clonic, or tonic-clonic. Patient characteristics and semiological features were compared. Spectral power and node degree, a network measure of connectivity, were calculated at two seizure epochs, electrographic and tonic-start.
Different GTCS subtypes occurred within individual patients. At electrographic-onset, all subtypes activated midline frontal cortex at delta/theta and beta frequencies but differed in network connectivity. In all subtypes, GTCS evolution from electrographic to tonic-start associated with preserved beta frequency spectral power, but reduced connectivity and delta/theta power.
Our findings suggest that at GTCS onset, the subtypes activate similar cortical regions and their different initial semiologies relate to their distinct onset long-range connectivity. Upon transition to the tonic-start epoch, the ictal activity is predominantly conveyed by β frequency activity and connectivity.
Future neurostimulation therapies for medically intractable GTCSs may target the same brain regions for all GTCS subtypes and may be most effective prior to the tonic-start epoch.
确定全面强直阵挛发作（GTCS）症状学亚型中的 EEG 时空激活和连通性。
在范德比尔特癫痫数据库中，确定了 39 名在视频脑电图监测期间发生 GTCS（n=58）的遗传性全面性癫痫（GGE）患者。GTCS 分为失神强直-阵挛、肌阵挛强直-阵挛和强直-阵挛。比较了患者特征和症状学特征。在两个发作期（电发作和强直起始）计算了频谱功率和节点度，这是一种连通性的网络度量。
不同的 GTCS 亚型在个体患者中发生。在电发作起始时，所有亚型均在 delta/theta 和 beta 频率下激活中线额皮质，但在网络连通性方面存在差异。在所有亚型中，GTCS 从电发作向强直起始的演变与 beta 频率谱功率的保留相关，但与连通性和 delta/theta 功率的降低相关。
我们的发现表明，在 GTCS 发作时，亚型激活相似的皮质区域，它们不同的初始症状学与它们不同的起始长程连通性有关。在向强直起始期过渡时，发作活动主要由β频率活动和连通性传递。
未来针对药物难治性 GTCS 的神经刺激疗法可能针对所有 GTCS 亚型的相同脑区，并且在强直起始期之前可能最有效。
