He Chenmin, Chen Cong, Yang Yuyu, Hu Lingli, Jin Bo, Ming Wenjie, Wang Zhongjin, Ding Yao, Ding Meiping, Wang Shuang, Wang Shan
Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China.
Neurol Ther. 2022 Jun;11(2):763-779. doi: 10.1007/s40120-022-00342-y. Epub 2022 Apr 4.
The aim was to evaluate the clinical characteristics and prognostic significance of subclinical seizures (SCSs) on scalp video-electroencephalogram (VEEG) monitoring with or without intracranial electroencephalogram (IEEG) monitoring in patients who had epilepsy surgery.
We reviewed 286 epileptic patients who underwent subsequent epilepsy surgery during scalp-VEEG evaluation with or without IEEG monitoring between 2013 and 2020, with a minimum follow-up of 1 year. The prevalence and clinical characteristics of SCSs, as well as their prognostic significance, were analyzed.
A total of 286 patients were enrolled for analysis, and 80 patients had IEEG implanted. SCSs were recorded in 9.79% of the patients based on VEEG and 50% based on IEEG. In the VEEG group (n = 286), younger seizure onset (P = 0.004) was associated with the presence of s-SCSs (SCSs detected on scalp VEEG). In the IEEG group (n = 80), temporal lobe epilepsy (P = 0.015) was associated with the presence of i-SCSs (SCSs detected on IEEG). Of 286 patients, 208 (72.73%) were seizure-free in the VEEG group, and 56 0f 80 patients (70%) were seizure-free in the IEEG group through the last follow-up. In the VEEG group, the presence of s-SCSs did not affect seizure outcome; predictors of seizure recurrence were longer epilepsy duration (P = 0.003, OR 1.003, 95% CI 1.001-1.005), history of focal to bilateral tonic-clonic seizure (P = 0.027, OR 1.665, 95% CI 1.060-2.613), nonspecific pathology (P = 0.018, OR 2.184, 95% CI 1.145-4.163), and incomplete resection (P = 0.004, OR 2.705, 95% CI 1.372-5.332). In the IEEG group, i-SCSs were significantly associated with seizure outcome (P = 0.028, OR 0.371, 95% CI 0.153-0.898).
The rate of SCSs captured on IEEG monitoring was higher than that on VEEG monitoring during presurgical evaluation. SCSs detected on VEEG monitoring were associated with younger seizure onset. SCSs detected on IEEG monitoring were associated with temporal lobe epilepsy and also predicted surgical outcomes in focal epilepsy.
目的是评估在接受癫痫手术的患者中，头皮视频脑电图（VEEG）监测联合或不联合颅内脑电图（IEEG）监测时亚临床发作（SCSs）的临床特征及预后意义。
我们回顾了2013年至2020年间在头皮VEEG评估期间接受或未接受IEEG监测并随后接受癫痫手术的286例癫痫患者，最短随访1年。分析了SCSs的发生率、临床特征及其预后意义。
共纳入286例患者进行分析，其中80例植入了IEEG。基于VEEG记录到SCSs的患者占9.79%，基于IEEG记录到SCSs的患者占50%。在VEEG组（n = 286）中，发作起始年龄较小（P = 0.004）与头皮VEEG检测到的亚临床发作（s-SCSs）相关。在IEEG组（n = 80）中，颞叶癫痫（P = 0.015）与颅内脑电图检测到的亚临床发作（i-SCSs）相关。286例患者中，VEEG组有208例（72.73%）在最后一次随访时无发作，IEEG组80例患者中有56例（70%）无发作。在VEEG组中，s-SCSs的存在不影响发作结局；发作复发的预测因素包括癫痫病程较长（P = 0.003，OR 1.003，95%CI 1.001 - 1.005）、有从局灶性发作进展为双侧强直阵挛性发作的病史（P = 0.027，OR 1.665，95%CI 1.060 - 2.613）、非特异性病理改变（P = 0.018，OR 2.184，95%CI 1.145 - 4.163）以及切除不完全（P = 0.004，OR 2.705，95%CI 1.372 - 5.332）。在IEEG组中，i-SCSs与发作结局显著相关（P = 0.028，OR 0.371，95%CI 0.153 - 0.898）。
术前评估期间，IEEG监测捕获SCSs的比率高于VEEG监测。VEEG监测检测到的SCSs与发作起始年龄较小相关。IEEG监测检测到的SCSs与颞叶癫痫相关，并且还可预测局灶性癫痫的手术结局。
