Cox Benjamin C, Khattak Jamal F, Starnes Keith, Brinkmann Benjamin H, Tatum William O, Noe Katherine H, Van Gompel Jamie J, Miller Kai J, Marsh W Richard, Grewal Sanjeet S, Zimmerman Richard S, So Elson L, Wong-Kisiel Lily C, Burkholder David B
Mayo Clinic, Department of Neurology, Rochester, MN, USA.
Henry Ford Hospital, Detroit, MI, USA.
Seizure. 2022 Oct;101:96-102. doi: 10.1016/j.seizure.2022.07.015. Epub 2022 Jul 29.
Although stereotactic EEG (sEEG) has become a widely used intracranial EEG technique, the significance of subclinical seizures (SCS) recorded on sEEG is unclear and studies examining this finding on sEEG are limited. We investigated (1) the prevalence of SCS in patients undergoing sEEG and clinical factors associated with their presence, (2) how often the subclinical seizure onset zone (SOZ) colocalizes with clinical SOZ, (3) the association of SCS and surgical outcomes, and (4) the influence of resection of the subclinical SOZ on surgical outcome.
We reviewed all patients who underwent intracranial monitoring with sEEG at our institution from 2015 through 2020 (n=169). Patient and seizure characteristics were recorded, as was concordance of subclinical and clinical seizures and post-surgical outcomes.
SCS were observed during sEEG monitoring in 84 of 169 patients (50%). There was no difference in the prevalence of SCS based on imaging abnormalities, temporal vs extratemporal SOZ, number of electrodes, or pathology. SCS were more common in females than males (62% vs 40%, p=0.0054). SCS had complete concordance with clinical SOZ in 40% of patients, partial concordance in 29%, overlapping in 19%, and discordant in 12%. Eighty-three patients had surgery, 44 of whom had SCS. There was no difference in excellent outcome (ILAE 12 or 2) based on the presence of SCS or SCS concordance with clinical SOZ; however, there were improved outcomes in patients with complete resection of the subclinical SOZ compared with patients with incomplete resection (p =0.013).
These findings demonstrate that SCS are common during sEEG and colocalize with the clinical SOZ in most patients. Discordance with clinical SOZ does not necessarily predict poor surgical outcome; rather, complete surgical treatment of the subclinical SOZ correlates with excellent outcome. For unclear reasons, subclinical seizures occurred more commonly in females than males.
尽管立体定向脑电图（sEEG）已成为一种广泛应用的颅内脑电图技术，但sEEG记录的亚临床发作（SCS）的意义尚不清楚，且研究这一sEEG发现的研究有限。我们调查了（1）接受sEEG检查的患者中SCS的患病率及其存在相关的临床因素，（2）亚临床发作起始区（SOZ）与临床SOZ共定位的频率，（3）SCS与手术结果的关联，以及（4）亚临床SOZ切除对手术结果的影响。
我们回顾了2015年至2020年在我院接受sEEG颅内监测的所有患者（n = 169）。记录了患者和发作特征，以及亚临床发作与临床发作的一致性和术后结果。
169例患者中有84例（50%）在sEEG监测期间观察到SCS。基于影像学异常、颞叶与颞外SOZ、电极数量或病理情况，SCS的患病率无差异。女性SCS比男性更常见（62%对40%，p = 0.0054）。40%的患者SCS与临床SOZ完全一致，29%部分一致，19%重叠，12%不一致。83例患者接受了手术，其中44例有SCS。基于SCS的存在或SCS与临床SOZ的一致性，良好结局（国际抗癫痫联盟12级或2级）无差异；然而，与未完全切除亚临床SOZ的患者相比，完全切除亚临床SOZ的患者结局有所改善（p = 0.013）。
这些发现表明，SCS在sEEG期间很常见，且在大多数患者中与临床SOZ共定位。与临床SOZ不一致不一定预示手术效果不佳；相反，亚临床SOZ的完全手术治疗与良好结局相关。原因不明的是，女性亚临床发作比男性更常见。
