Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan.
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Epilepsia Open. 2022 Sep;7(3):474-487. doi: 10.1002/epi4.12631. Epub 2022 Aug 1.
This retrospective study was designed to observe differences in ictal movements of epileptic spasm (ES) before and after corpus callosotomy (CC). We hypothesized that asymmetric expression of ES is more clarified after CC and would be a good indicator for the epileptic hemisphere.
We selected 16 patients with intractable ES in West syndrome who were seizure-free after CC and subsequent resection or disconnective surgery of the unilateral hemisphere. We retrospectively reviewed their behavioral ES recorded at video-electroencephalography monitoring before and after CC. Asymmetric neck flexion (NF) and involuntary muscular contraction of the upper and lower extremities (MCU and MCL, respectively) were primarily described correlating their laterality and the responsible hemisphere proved by surgical resection.
Asymmetric NF, MCU, and MCL could be found both before and after CC. However, the percentage of those movements to the total number of ES increased after CC; asymmetric NF, 82.9% vs. 20.1%; unilaterally predominant MCU, 81% vs. 39.3%; and unilaterally predominant MCL, 77.6% vs. 29.9%. Regarding asymmetric NF, the direction in which the neck flexed or the head turned was significantly ipsilateral to the responsible hemisphere in 9 of 12 patients after CC (75%). The predominant side of MCU and MCL were significantly contralateral to the responsible hemisphere in 11 of 11 and 7 of 9 patients (100% and 77.8%, respectively).
Asymmetric NF, MCU, and MCL were clarified in patients with ES who were successfully treated with CC and subsequent surgery. Those changes in ictal behaviors after CC may indicate the lateralization of epileptic activity and encourage more curative surgical treatment.
本回顾性研究旨在观察胼胝体切开术（CC）前后癫痫痉挛（ES）发作时运动的差异。我们假设 ES 的不对称表达在 CC 后更加明显，并且将成为癫痫半球的良好指标。
我们选择了 16 例 West 综合征患者，这些患者在 CC 后、单侧半球切除或离断性手术后无癫痫发作。我们回顾性分析了他们在 CC 前后视频脑电图监测记录的行为性 ES。主要描述不对称性颈屈（NF）和上下肢不随意肌肉收缩（MCU 和 MCL）与手术切除确定的侧性和责任半球的相关性。
CC 前后均可发现不对称性 NF、MCU 和 MCL。然而，CC 后这些运动占 ES 总数的比例增加；不对称性 NF，82.9%比 20.1%；单侧优势 MCU，81%比 39.3%；单侧优势 MCL，77.6%比 29.9%。关于不对称性 NF，在 CC 后 12 例患者中有 9 例（75%），颈部弯曲或头部转动的方向明显与责任半球同侧。在 11 例患者中，MCU 和 MCL 的优势侧明显与责任半球相反（100%和 77.8%），在 7 例患者中，9 例患者中（100%和 77.8%），MCU 和 MCL 的优势侧明显与责任半球相反。
在成功接受 CC 治疗和随后手术的 ES 患者中，不对称性 NF、MCU 和 MCL 得到了阐明。CC 后这些发作行为的变化可能表明癫痫活动的偏侧化，并鼓励进行更有效的手术治疗。
