Chan Alvin Y, Lien Brian V, Brown Nolan J, Gendreau Julian, Beyer Ryan S, Yang Chen Yi, Choi Elliot H, Hsu Frank P K, Vadera Sumeet
Department of Neurological Surgery, University of California, 200 South Manchester Avenue, Suite 201, Orange, CA, 92868, United States.
Johns Hopkins Whiting School of Engineering, 3400 North Charles Street, Baltimore, MD, 21218, United States.
Ann Med Surg (Lond). 2022 Jul 9;80:104139. doi: 10.1016/j.amsu.2022.104139. eCollection 2022 Aug.
Surgery can be an effective treatment for epilepsy if the seizure onset is adequately localized. Invasive monitoring is used if noninvasive methods are inconclusive. Initial invasive monitoring may fail if the pre-surgical hypothesis regarding location of epileptic foci is wrong. At this point, a decision must be made whether to remove all electrodes without a clearly defined location of onset or to implant additional electrodes with the aim of achieving localization by expanding coverage.
Electrodes were placed according to a hypothesis derived from noninvasive monitoring techniques in adult patients with long term epilepsy. Seizure onset was not clearly localized at the end of the invasive monitoring period in ten patients, and additional electrodes were placed based on a new hypothesis that incorporated data from the invasive monitoring period.
Successful localization was achieved in nine patients. There were no complications with adding additional electrodes. At final follow up, four patients were seizure free while four others had at least a 50% reduction in seizures after undergoing surgical intervention.
Seizure foci were localized safely in 90% of adult patients with long term epilepsy after implanting additional electrodes and expanding coverage. Patients undergoing invasive monitoring without clear localization should have additional electrodes placed to expand monitoring coverage as it is safe and effective.
如果癫痫发作起始部位能够充分定位，手术可以成为治疗癫痫的有效方法。如果非侵入性方法无法得出结论，则采用侵入性监测。如果术前关于癫痫病灶位置的假设错误，初始侵入性监测可能会失败。此时，必须做出决定，是在未明确发作部位的情况下移除所有电极，还是植入额外电极以扩大覆盖范围从而实现定位。
根据从非侵入性监测技术得出的假设，为患有长期癫痫的成年患者放置电极。在10名患者的侵入性监测期结束时，癫痫发作起始部位未明确定位，基于纳入侵入性监测期数据的新假设放置了额外电极。
9名患者成功实现定位。添加额外电极没有出现并发症。在最后一次随访时，4名患者无癫痫发作，另外4名患者在接受手术干预后癫痫发作至少减少了50%。
在植入额外电极并扩大覆盖范围后，90%的成年长期癫痫患者的癫痫病灶被安全定位。对于在侵入性监测中未明确定位的患者，应放置额外电极以扩大监测覆盖范围，因为这是安全有效的。
