Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
Epileptic Disord. 2022 Oct 1;24(5):947-951. doi: 10.1684/epd.2022.1459.
Temporal lobe epilepsy is the most common form of focal epilepsy and is frequently resistant to antiseizure medication. Non-invasive biomarkers are crucial when resective epilepsy surgery is considered in order to guide diagnostic work-up and management. Interictal epileptiform discharges, when concordant with ictal EEG recording and a focal abnormality on functional imaging or anatomic MRI in patients with temporal lobe epilepsy, portend a favorable outcome with resective or ablative surgery. An interictal non-epileptiform feature on EEG believed to have the same localizing potential as epileptiform discharges is temporal intermittent rhythmic delta activity (TIRDA). The precise localization of TIRDA has been a subject of debate, but has been associated with seizures that arise from the temporal region. We report a 64-year-old female who underwent unsuccessful right anterior temporal lobectomy for drug-resistant focal epilepsy, suspected to originate from the right temporal lobe. Subsequent video-EEG monitoring revealed right, greater than left, TIRDA and interictal epileptiform discharges arising from the temporal regions bilaterally, despite a generous temporal lobectomy demonstrated by brain MRI. Further, using EEG source localization, we identified TIRDA using scalp EEG in sensor space, localized to the ipsilateral orbitofrontal region. We discuss the proposed localization of TIRDA in this case and address the importance of characterizing TIRDA in the presurgical evaluation of patients with epilepsy.
颞叶癫痫是最常见的局灶性癫痫，常对抗癫痫药物耐药。在考虑进行致痫性癫痫手术时，非侵入性生物标志物至关重要，以便指导诊断性检查和管理。在颞叶癫痫患者中，当癫痫样放电与发作期脑电图记录和功能成像或解剖 MRI 的局灶性异常一致时，预示着切除性或消融性手术有良好的预后。脑电图上的一种非癫痫样间歇性节律性 delta 活动（TIRDA）被认为具有与癫痫样放电相同的定位潜力的间歇性非癫痫样特征。TIRDA 的精确定位一直存在争议，但与起源于颞叶的癫痫发作有关。我们报告了一位 64 岁女性，她因耐药性局灶性癫痫接受了不成功的右侧前颞叶切除术，怀疑起源于右侧颞叶。随后的视频脑电图监测显示右侧 TIRDA 大于左侧，双侧颞叶出现发作间期癫痫样放电，尽管脑 MRI 显示颞叶切除术范围广泛。此外，我们使用脑电图源定位，在传感器空间中使用头皮脑电图识别 TIRDA，定位到同侧眶额区。我们讨论了在这种情况下 TIRDA 的拟议定位，并讨论了在癫痫患者的术前评估中描述 TIRDA 的重要性。
