Assuta Medical Center, Functional Neurosurgerie Group, Tel Aviv, Israel.
Ben-Gurion of the Negev Department of Brain and Cognitive Sciences, Beer Sheva, Israel.
Epilepsia Open. 2023 Jun;8(2):298-306. doi: 10.1002/epi4.12612. Epub 2023 Mar 28.
We will demonstrate that FIRDA (frontal intermittent rhythmic delta activity)-otherwise related to systemic disorders and encephalopathy-has a role as an epileptic biomarker of deep-seated midline SOZ. Its abolishment following SEEG-guided radiofrequency of such SOZ correlates with clinical improvement suggesting its role as a noninvasive biomarker of otherwise inaccessible SOZs.
We report the case of AK who was admitted with "psychiatric and gastrointestinal complaints." AK's complaints were further associated with FIRDA during VEEG. His previous refractoriness to AEDs, the clinico-electroencephalographic correlation, MRI showing bilateral hippocampal atrophy (more to the left) and severe memory deficits, prompted us to suggest a left temporo-mesial SOZ, for which SEEG was done. Dual SEEG and scalp electrodes were used primarily for diagnostic purposes but taking into account an option for a therapeutic action by RF ablation.
The dual array demonstrated a clear association between left hippocampal high voltage spikes and HFOs on SEEG recordings with FIRDA on concomitant scalp EEG parallel to behavioral changes, as suspected in our preliminary hypothesis. A further RF ablation eliminated the epileptiform activity (Spikes, HFOs, and FIRDA) followed by clinical improvement.
This is the first report showing the clinical significance of FIRDA associated with behavioral changes as a marker for latent refractory mesial epilepsy. SEEG exploration has the potential to uncover deep sources, which are manifested as FIRDA on scalp EEG. These abnormalities and clinical symptoms can be eliminated by RF ablation.
我们将证明 FIRDA（额部间歇性节律性德尔塔活动）——与系统性疾病和脑病有关——作为深部中线 SOZ 的癫痫生物标志物的作用。对这些 SOZ 进行 SEEG 引导下的射频消融后，其消失与临床改善相关，这表明其作为深部不可触及 SOZ 的非侵入性生物标志物的作用。
我们报告了 AK 的病例，他因“精神和胃肠道投诉”入院。AK 的投诉在 VEEG 期间与 FIRDA 进一步相关。他以前对抗癫痫药物的反应性差、临床-脑电图相关性、显示双侧海马萎缩（更偏向左侧）和严重记忆障碍的 MRI，促使我们建议进行左侧颞内侧 SOZ，为此进行了 SEEG。双 SEEG 和头皮电极主要用于诊断目的，但考虑到射频消融的治疗选择。
双阵列清楚地表明，左海马高电压尖峰与 SEEG 记录中的 HFO 与伴随的头皮 EEG 上的 FIRDA 之间存在明确的关联，这与我们初步假设中的行为变化相一致。进一步的射频消融消除了癫痫样活动（尖峰、HFO 和 FIRDA），随后出现临床改善。
这是第一个显示与行为变化相关的 FIRDA 作为潜在难治性内侧癫痫标志物的临床意义的报告。SEEG 探索具有揭示深部来源的潜力，这些来源在头皮 EEG 上表现为 FIRDA。这些异常和临床症状可以通过射频消融消除。
