Kalss Gudrun, Pelliccia Veronica, Zimmermann Georg, Trinka Eugen, Tassi Laura
Department of Neurology and Centre for Cognitive Neurosciences, Christian Doppler University Hospital, Paracelsus Medical University, Member of the European Reference Network EpiCARE, Salzburg, Austria.
"Claudio Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Milan, Italy.
J Clin Neurophysiol. 2025 Mar 1;42(3):215-223. doi: 10.1097/WNP.0000000000001106. Epub 2024 Jul 23.
Scalp-EEG incompletely covers the frontal lobe cortex. Underrepresentation of frontobasal or frontomesial structures, fast ictal spreading, and false lateralization impede scalp-EEG interpretation. Hence, we investigated the significance of scalp-EEG in the presurgical workup of frontal lobe epilepsy.
Using descriptive statistical methods and Pearson chi-squared test for group comparisons, we retrospectively investigated postsurgical outcome, interictal epileptiform discharges (iiEDs), and electrographic seizure patterns on scalp-EEG in 81 consecutive patients undergoing resective epilepsy surgery within the margins of the frontal lobe.
Postoperatively, patients with frontopolar iiEDs ( n = 7) or concordant frontopolar iiED focus and seizure-onset ( n = 2) were seizure free ( n = 7/7, Engel Ia). MRI-positive patients with frontopolar iiEDs or frontopolar seizure-onset ( n = 1/8 Engel Id, n = 7/8 Engel Ia) underwent surgery without stereo-EEG. Thirteen of 16 patients with frontolateral ( n = 8/10, Engel Ia), or left frontobasal ( n = 5/6, Engel Ia) seizure-onset undergoing further stereo-EEG, were seizure-free postoperatively. Seizure-onset prevalent over one electrode ( n = 37/44 Engel I, p = 0.02), fast activity (FA)/flattening at seizure-onset ( n = 29/33 Engel I, p = 0.02), FA/flattening during the seizure ( n = 38/46 Engel I, p = 0.05), or focal rhythmic sharp-/spike-/polyspike-and-slow waves during the seizure ( n = 24/31, Engel Ia, p = 0.05) were favorable prognostic markers. Interictal polyspike waves ( p = 0.006 for Engel Ia) and interictal paroxysmal FA ( p = 0.02 for Engel I) were unfavorable prognostic markers.
Frontopolar scalp-EEG findings serve as biomarkers for predicting favorable surgical outcome in lesional frontal lobe epilepsy. Consequently, careful analysis of scalp-EEG assists in bypassing stereo-EEG in these patients.
头皮脑电图不能完全覆盖额叶皮质。额基底或额内侧结构显示不足、发作期快速扩散以及错误的定侧会妨碍头皮脑电图的解读。因此，我们研究了头皮脑电图在额叶癫痫术前评估中的意义。
我们采用描述性统计方法和Pearson卡方检验进行组间比较，回顾性研究了81例在额叶范围内接受切除性癫痫手术的连续患者的术后结果、发作间期癫痫样放电（iiEDs）以及头皮脑电图上的脑电图发作模式。
术后，额极iiEDs患者（n = 7）或额极iiEDs病灶与发作起始一致的患者（n = 2）无癫痫发作（n = 7/7，Engel Ia级）。MRI阳性且有额极iiEDs或额极发作起始的患者（n = 1/8为Engel Id级，n = 7/8为Engel Ia级）未进行立体脑电图检查即接受了手术。16例发作起始位于额外侧（n = 8/10，Engel Ia级）或左额基底（n = 5/6，Engel Ia级）且接受进一步立体脑电图检查的患者中，有13例术后无癫痫发作。发作起始集中在一个电极上（n = 37/44为Engel I级，p = 0.02）、发作起始时出现快速活动（FA）/波幅压低（n = 29/33为Engel I级，p = 0.02）、发作期出现FA/波幅压低（n = 38/46为Engel I级，p = 0.05）或发作期出现局灶性节律性尖波/棘波/多棘波和慢波（n = 24/31，Engel Ia级，p = 0.05）是良好的预后指标。发作间期多棘波（Engel Ia级，p = 0.006）和发作间期阵发性FA（Engel I级，p = 0.02）是不良的预后指标。
额极头皮脑电图检查结果可作为预测有病灶的额叶癫痫患者手术预后良好的生物标志物。因此，对头皮脑电图进行仔细分析有助于这些患者避免进行立体脑电图检查。
