Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S60, Cleveland, OH 44195, United States; University of Pittsburgh Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S60, Cleveland, OH 44195, United States; Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, China.
Seizure. 2024 Oct;121:226-234. doi: 10.1016/j.seizure.2024.08.016. Epub 2024 Aug 24.
We aimed to analyze seizure outcomes and define ictal onset with intracranial electroencephalography (ICEEG) in patients with polymicrogyria (PMG)-related drug-resistant epilepsy (DRE), considering surrounding cortex and extent of surgical resection.
Retrospective study of PMG-diagnosed patients (2001 to June 2018) at a single epilepsy center was performed. Primary outcome was complete seizure freedom (SF), based on Engel classification with follow-up of ≥ 1 year. Univariate analyses identified predictive clinical variables, later integrated into multivariate Cox proportional hazards models.
Thirty-five patients with PMG-related DRE (19 adults/16 pediatric: 20 unilateral/15 bilateral) were studied. In surgical group (n = 23), 52 % achieved SF (mean follow-up:47 months), whereas none in non-resective treatment group (n = 12) attained SF (mean follow-up:39.3 months) (p = 0.002). In surgical group, there were no significant differences in SF, based on the laterality of the PMG [uni or bilateral,p = 0.35], involvement of perisylvian region(p = 0.714), and extent of the PMG resection [total vs. partial,p = 0.159]. Patients with ictal ICEEG onset in both PMG and non-PMG cortices, and those limited to non- PMG cortices had a greater chance of achieving SF compared to those limited to the PMG cortices.
Resective surgery guided by ICEEG for defining the epileptogenic zone (EZ), in DRE patients with PMG, leads to favorable seizure outcomes. ICEEG-guided focal surgical resection(s) may lead to SF in patients with bilateral or extensive unilateral PMG. ICEEG aids in EZ localization within and/or outside the MRI-identified PMG. Complete removal of PMG identified on MRI does not guarantee SF. Hence, developing preimplantation hypotheses based on epileptogenic networks evaluation during presurgical assessment is crucial in this patient population.
我们旨在分析颅内脑电图 (ICEEG) 指导下伴多微小脑回畸形 (PMG) 的耐药性癫痫 (DRE) 患者的癫痫发作结局，并定义致痫区 (EZ)，同时考虑到周围皮质和手术切除范围。
对单中心的 PMG 诊断患者（2001 年至 2018 年 6 月）进行回顾性研究。主要结局是基于 Engel 分类的完全无癫痫发作（Engel class I），随访时间≥1 年。单变量分析确定了预测性临床变量，随后整合到多变量 Cox 比例风险模型中。
研究了 35 例 PMG 相关 DRE 患者（19 例成人/16 例儿童：20 例单侧/15 例双侧）。在手术组（n=23）中，52%的患者达到完全无癫痫发作（平均随访时间：47 个月），而非手术治疗组（n=12）无一例达到完全无癫痫发作（平均随访时间：39.3 个月）（p=0.002）。在手术组中，PMG 的单侧性[单侧或双侧，p=0.35]、累及侧脑室周围区域[累及或未累及，p=0.714]以及 PMG 切除范围[完全切除或部分切除，p=0.159]与完全无癫痫发作无显著相关性。与致痫区局限于 PMG 相比，致痫区起源于 PMG 和非 PMG 皮质或局限于非 PMG 皮质的患者有更大的机会达到完全无癫痫发作。
在伴 DRE 的 PMG 患者中，ICEEG 指导下的致痫区切除术可获得良好的癫痫发作结局。ICEEG 指导下的局灶性手术切除可能使双侧或单侧广泛 PMG 患者获得完全无癫痫发作。ICEEG 有助于在 MRI 识别的 PMG 内和/或外定位 EZ。MRI 识别的 PMG 完全切除并不能保证完全无癫痫发作。因此，在这一患者群体中，基于术前评估中致痫性网络评估制定植入前假说至关重要。
