Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands.
Department of Neurosurgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Maastricht Heeze, the Netherlands.
Seizure. 2024 Oct;121:105-113. doi: 10.1016/j.seizure.2024.07.016. Epub 2024 Aug 8.
Periventricular nodular heterotopias (PVNH) are developmental abnormalities with neurons abnormally clustered around the cerebral ventricles. Patients frequently present with focal drug-resistant epilepsy (DRE). However, the relationship between PVNH and the seizure onset zone (SOZ) is complex. Stereo-electroencephalography (SEEG) is an invasive diagnostic procedure for patients with DRE. In selected patients, the SEEG may be converted into a therapeutic procedure, lesioning the probable (SOZ) with pulsed radiofrequency thermocoagulation (RFTC). The aim of our study was to evaluate the efficacy and safety of SEEG-RFTC in a series of DRE patients with PVNH.
Twenty-four patients with focal DRE related to PVNH and treated with SEEG-guided-RFTC restricted to nodules were prospectively collected between 2016 and 2023 and retrospectively analyzed after a follow-up of at least 12 months.
Seventeen patients (71 %) responded (ILAE class 1-4) after SEEG-guided RFTC of whom eleven (46 %) became seizure-free (class 1) at last follow up, nine (45 %) despite residual PVNH tissue on MRI. SEEG seizure onset was restricted to PVNH in eleven patients (class 1 in 45 %) and simultaneously in PVNH and other cortical areas in thirteen patients (class 1 in 46 %). Out of 31 SEEG-RFTC procedures in twenty-four patients, adverse events, related to RFTC, were recorded in eight (26 %), of which two patients (8 %) had predicted permanent visual complaints whilst the other five had transient complaints.
This study demonstrates that a considerable percentage of patients, even with bilateral, multiple PVNH and involvement of adjacent cortical regions can be rendered seizure-free with SEEG-guided-RFTC restricted to the nodules. Furthermore, this study delivers evidence that the complete destruction of the entire nodule is not necessary to render a patient seizure free. This justifies the use of SEEG in patients with single, multiple or bilateral PVNHs to provide insight into the epileptogenic organization in and around these lesions.
室管膜下结节性异位（PVNH）是一种神经元异常聚集在脑室周围的发育异常。患者常表现为局灶性耐药性癫痫（DRE）。然而，PVNH 与致痫区（SOZ）之间的关系很复杂。立体脑电图（SEEG）是 DRE 患者的一种有创诊断程序。在选择的患者中，SEEG 可转化为治疗程序，用脉冲射频热凝（RFTC）对可能的（SOZ）进行病变。我们的研究目的是评估在一系列伴有 PVNH 的 DRE 患者中，SEEG-RFTC 的疗效和安全性。
2016 年至 2023 年期间，前瞻性收集了 24 例因 PVNH 相关局灶性 DRE 而接受 SEEG 引导 RFTC 治疗的患者，并在至少 12 个月的随访后进行回顾性分析。
SEEG 引导 RFTC 后，17 例患者（71%）有反应（ILAE 1-4 级），其中 11 例（46%）在最后一次随访时无癫痫发作（1 级），9 例（45%）尽管 MRI 上仍有残留的 PVNH 组织。11 例患者的 SEEG 发作仅限于 PVNH（45%为 1 级），13 例患者的 SEEG 发作同时位于 PVNH 和其他皮质区（46%为 1 级）。在 24 例患者的 31 次 SEEG-RFTC 手术中，有 8 次（26%）记录到与 RFTC 相关的不良事件，其中 2 例（8%）有预测性的永久性视力障碍，而另外 5 例有短暂性的不良事件。
本研究表明，相当一部分患者，即使是双侧、多发 PVNH 并累及相邻皮质区，也可以通过 SEEG 引导的 RFTC 治疗得到控制。此外，本研究提供了证据，即完全破坏整个结节并不必要使患者无癫痫发作。这证明了在伴有单发、多发或双侧 PVNH 的患者中使用 SEEG 来了解这些病变及其周围的致痫组织。
