内侧颞叶硬化患者的立体定向脑电图癫痫灶定位：单中心经验

Stereo-electroencephalographic seizure localization in patients with mesial temporal sclerosis: A single center experience.

作者信息

Zhang Bill, Podkorytova Irina, Hays Ryan, Perven Ghazala, Agostini Mark, Harvey Jay, Zepeda Rodrigo, Alick-Lindstrom Sasha, Dieppa Marisara, Doyle Alex, Das Rohit, Lega Bradley, Ding Kan

机构信息

UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.

UT Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.

出版信息

Clin Neurophysiol Pract. 2024 Feb 28;9:106-111. doi: 10.1016/j.cnp.2024.02.002. eCollection 2024.

DOI:10.1016/j.cnp.2024.02.002

PMID:38516616

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10955192/

Abstract

OBJECTIVE

Epilepsy patients with mesial temporal sclerosis (MTS) on imaging who are drug-resistant usually undergo epilepsy surgery without previous invasive evaluation. However, up to one-third of patients are not seizure-free after surgery. Prior studies have identified risk factors for surgical failure, but it is unclear if they are associated with bilateral or discordant seizure onset.

METHODS

In this retrospective case series, we identified 17 epilepsy patients who had MRI-confirmed MTS but received invasive stereo-EEG (SEEG) evaluation before definitive intervention. We analyzed their presurgical risk factors in relation to SEEG seizure onset localization and MRI/SEEG concordance.

RESULTS

SEEG ictal onset was concordant with MTS localization (i.e. seizures started only from the hippocampus with MTS) in 5 out of 13 patients with unilateral MTS (UMTS) and in 3 out of 4 patients with bilateral MTS.No statistically significant association regarding concordance of SEEG ictal onset and MTS location was found in patients with such risk factors as a history of non-mesial temporal aura, frequent focal to bilateral tonic-clonic seizures, prior viral brain infection, or family history of epilepsy. Nine out of 13 UMTS patients had resective surgery only, 5 out of 9 (56 %) have Engel class I outcome at most recent follow-up (median 46.5 months, range 22-91 months). In Engel class I cohort, the SEEG ictal onset was concordant with MTS location in 3 out of 5 patients, and 2 patients had ipsilateral temporal neocortical ictal onset.

CONCLUSIONS

Our findings suggest that patients with MTS might have discordant SEEG ictal onset (in 61.5% patients with UMTS in presented cohort), which may explain poor surgical outcome after destructive surgery in these cases.

SIGNIFICANCE

Although no statistically significant association was found in this under-powered study, these findings could be potentially valuable for future -analyses.

摘要

目的

影像学显示患有内侧颞叶硬化（MTS）的耐药癫痫患者通常在未进行先前侵入性评估的情况下接受癫痫手术。然而，高达三分之一的患者术后仍未实现无癫痫发作。先前的研究已经确定了手术失败的风险因素，但尚不清楚它们是否与双侧或不一致的癫痫发作起始有关。

方法

在这个回顾性病例系列中，我们确定了17例MRI证实患有MTS但在最终干预前接受了侵入性立体脑电图（SEEG）评估的癫痫患者。我们分析了他们术前的风险因素与SEEG癫痫发作起始定位以及MRI/SEEG一致性的关系。

结果

在13例单侧MTS（UMTS）患者中有5例以及4例双侧MTS患者中有3例，SEEG发作起始与MTS定位一致（即癫痫发作仅起源于伴有MTS的海马体）。在具有非内侧颞叶先兆病史、频繁的局灶性至双侧强直阵挛发作、先前病毒性脑感染或癫痫家族史等风险因素的患者中，未发现SEEG发作起始与MTS位置一致性方面具有统计学意义的关联。13例UMTS患者中有9例仅接受了切除手术，9例中的5例（56%）在最近一次随访（中位时间46.5个月，范围22 - 91个月）时达到Engel I级结局。在Engel I级队列中，5例患者中有3例SEEG发作起始与MTS位置一致，2例患者有同侧颞叶新皮质发作起始。