Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Matsubara Tokushukai Hospital, Osaka, Japan.
Oper Neurosurg (Hagerstown). 2022 Aug 1;23(2):164-173. doi: 10.1227/ons.0000000000000245. Epub 2022 Apr 29.
To ensure that epilepsy surgery is effective, accurate presurgical localization of the epileptogenic zone is essential. Our previous reports demonstrated that interictal high gamma oscillation (30-70 Hz) regularity (GOR) on intracranial electroencephalograms is related to epileptogenicity.
To examine whether preoperative GOR analysis with interictal high-density electroencephalography (HD-EEG) improves the accuracy of epileptogenic focus localization and enhances postoperative seizure control.
We calculated GOR from 20 seconds of HD-EEG data for 21 patients with refractory focal epilepsy (4 with nonlesional temporal lobe epilepsy) scheduled for epilepsy surgery. Low-resolution brain electromagnetic tomography was used to analyze the high GOR source. To validate our findings, we made comparisons with other conventional localization methods and postoperative seizure outcomes.
In all patients, the areas of interictal high GOR were identified and resected. All patients were seizure-free after the operation. The concordance between the results of interictal high GOR on HD-EEG and those of source estimation of interictal discharge was fully overlapping in 10 cases, partially overlapping in 8 cases, and discordant in 3 cases. The concordance between the results of interictal high GOR on HD-EEG and those of interictal 123 I-iomazenil single-photon emission computed tomography was fully overlapping in 8 cases, partially overlapping in 11 cases, and discordant in 2 cases. In 4 patients with nonlesional temporal lobe epilepsy, the interictal high GOR on HD-EEG was useful in confirming the epileptogenic zone.
The interictal high GOR on HD-EEG is an excellent marker for presurgical epileptogenic zone localization.
为确保癫痫手术的有效性，准确的术前致痫灶定位至关重要。我们之前的报告表明，颅内脑电图（EEG）的发作间期高频γ节律（GOR）的规律性与致痫性相关。
研究术前发作间期高密度脑电图（HD-EEG）的 GOR 分析是否能提高致痫灶定位的准确性，并增强术后的癫痫控制效果。
我们对 21 例药物难治性局灶性癫痫患者（4 例为非病变性颞叶癫痫）进行了术前 GOR 分析，计算了 20 秒 HD-EEG 数据的 GOR。采用低分辨率脑电磁层析成像分析高 GOR 源。为了验证我们的发现，我们将其与其他常规定位方法和术后癫痫发作结果进行了比较。
在所有患者中，都确定并切除了发作间期高 GOR 区域。所有患者术后均无癫痫发作。发作间期高 GOR 结果与发作间期放电源估计结果的一致性在 10 例中完全一致，8 例部分一致，3 例不一致。发作间期高 GOR 结果与发作间期 123 I-iomazenil 单光子发射计算机断层扫描结果的一致性在 8 例中完全一致，11 例部分一致，2 例不一致。在 4 例非病变性颞叶癫痫患者中，发作间期 HD-EEG 的高 GOR 有助于确认致痫区。
发作间期 HD-EEG 的 GOR 是术前致痫灶定位的优秀标志物。
