Wang Shuang, Liu Chang, Zhang Hongwei, Liu Qingzhu, Ji Taoyun, Zhu Ying, Fan Yan, Yu Hao, Yu Guojing, Wang Wen, Wang Dongming, Cai Lixin, Liu Xiaoyan
Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Front Neurol. 2022 Jul 22;13:922778. doi: 10.3389/fneur.2022.922778. eCollection 2022.
To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified MRI was the only factor associated with a positive surgical outcome.
为分析癫痫发作症状学、脑电图（EEG）特征及磁共振成像（MRI）改变对癫痫性痉挛（ES）患儿致痫区定位及手术预后的影响。对127例接受手术治疗的药物难治性癫痫合并ES患儿的数据进行回顾性分析。ES症状学分为非侧化、双侧不对称和局灶性。发作间期癫痫样放电分为弥漫性或多灶性、单侧性和局灶性。MRI结果显示所有患者均有可见的局部病变，而致痫区定位的解剖-电-临床价值取决于手术结果。术前视频脑电图监测期间，127例患者中，53例（41.7%）仅有ES，46例（36.2%）有ES和局灶性发作，17例（13.4%）有ES和全身性发作，11例（8.7%）有ES合并局灶性和全身性发作。值得注意的是，35例（27.6%）和92例（72.4%）分别表现为简单型和复杂型ES。发作间期脑电图显示，22例（17.3%）有双侧多灶性放电或高度节律失调，25例（19.7%）有单侧优势放电，80例（63.0%）有明确的局灶性或区域性放电。发作期放电在71例（55.9%）中为全身性/双侧性，在56例（44.1%）中为明确/侧化性。手术切除的病变位于半球（28.3%）、额叶（24.4%）、颞叶（16.5%）、颞顶枕区（14.2%）和后皮质区（8.7%）。术后1年和4年的无发作率分别为81.8%和72.7%。ES的电临床特征与无发作率之间无显著差异。该队列中的大多数患者手术治疗效果良好。ES的症状学和发作期脑电图改变对定位无影响，而发作间期脑电图的局灶性或侧化性癫痫样放电可能影响侧化和定位。MRI确定的致痫性病变的完全切除是与手术阳性结果相关的唯一因素。
