Department of Neurology, Government Medical College, Kozhikode, India.
Epileptic Disord. 2023 Apr;25(2):173-186. doi: 10.1002/epd2.20009. Epub 2023 May 3.
We sought to study the spatio-temporal propagation of occipito-frontal spikes in childhood epilepsies by voltage mapping and dipole localization and identify types of occipito-frontal spikes based on onset, propagation, and stability of their dipoles.
Sleep EEG data of children, aged 1-14 years, with a minimum 1 h of recording from June 2018 to June 2021, were analyzed to identify occipito-frontal spikes. In total, 150 successive occipito-frontal spikes were manually selected from each EEG and using a source localization software were averaged using automated pattern matching with a threshold of 80%, and sequential 3D voltage maps of averaged spike were analyzed. Stability quotient (SQ) was calculated as the total number of averages/150. Stable dipole was defined as SQ ≥ .8. Dipole analysis was performed with principal component analysis using an age-appropriate template head model.
Ten children with occipito-frontal spikes were identified; five with self-limited epilepsy with autonomic seizures (SeLEAS) and five with non-SeLEAS epilepsies. Three types of occipito-frontal spikes were identified: (1) narrow occipito-frontal spikes with stable dipoles seen in all five children with SeLEAS which were "apparently" synchronous and bilateral clone-like with an occipito-frontal interval of 10-30 ms and a homogeneous propagation pattern from a unilateral medial parieto-occipital region to an ipsilateral mesial frontal region; (2) wide occipito-frontal spikes with stable dipoles seen in one child with non-SeLEAS and developmental and/or epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS) with an occipito-frontal interval of 45 ms, caused by focal spike propagation from a deeper temporal focus to ipsilateral peri-rolandic cortex; and (3) wide occipito-frontal spikes with unstable dipoles seen in four children with non-SeLEAS lesional epilepsies with an occipito-frontal latency of >50 ms and heterogeneous propagation patterns with poor intra-individual dipole stability.
We successfully identified different types of occipito-frontal spikes in childhood epilepsies. Although the term "occipito-frontal" is used to describe these spikes on the 10-20 EEG system, true propagation from occipital to frontal regions is not necessary. It is possible to differentiate idiopathic from symptomatic cases by analyzing the stability quotient and the occipito-frontal interval of occipito-frontal spikes.
通过电压映射和偶极子定位研究儿童癫痫中的枕额棘波的时空传播，并根据偶极子的起始、传播和稳定性来确定枕额棘波的类型。
对 2018 年 6 月至 2021 年 6 月期间至少记录 1 小时的 1-14 岁儿童的睡眠脑电图数据进行分析，以识别枕额棘波。总共从每个 EEG 中手动选择 150 个连续的枕额棘波，使用源定位软件，通过 80%的自动模式匹配进行平均，然后对平均棘波的连续 3D 电压图进行分析。稳定性商数（SQ）计算为平均总数/150。稳定偶极子定义为 SQ≥0.8。使用适合年龄的模板头部模型进行主成分分析进行偶极子分析。
确定了 10 例枕额棘波患儿，其中 5 例为伴有自主神经发作的自限性癫痫伴癫痫发作（SeLEAS），5 例为非 SeLEAS 癫痫。识别出三种类型的枕额棘波：（1）5 例 SeLEAS 患儿均可见稳定偶极子的窄枕额棘波，这些棘波呈“明显”同步双侧克隆样，枕额间隔为 10-30ms，从单侧内侧顶枕区到同侧内侧额区呈均匀传播模式；（2）1 例非 SeLEAS 伴发育性和/或癫痫性脑病伴睡眠中棘波-慢波激活（D/EE-SWAS）患儿可见稳定偶极子的宽枕额棘波，枕额间隔为 45ms，由从较深的颞叶病灶向同侧额眶回传播引起；（3）4 例非 SeLEAS 局灶性癫痫患儿可见不稳定偶极子的宽枕额棘波，枕额潜伏期>50ms，传播模式具有异质性，个体内偶极子稳定性差。
我们成功地在儿童癫痫中识别出不同类型的枕额棘波。尽管这些棘波在 10-20 脑电图系统上被描述为“枕额”，但并不一定需要从枕部到额部的真正传播。通过分析枕额棘波的稳定性商数和枕额间隔，可以区分特发性和症状性病例。
