Sánchez-Boluarte Sofía S, Aguirre-Quispe Wilfor, Herrera Aramburú Manuel, Tatum William O, De La Cruz Ramírez Walter
School of Medicine, Cesar Vallejo University, Av. Victor Larco, Trujillo, Trujillo, 1770, Peru.
Departamento de Epilepsia, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Lima, Lima, 15001, Peru.
Acta Epileptol. 2023 Jul 18;5(1):18. doi: 10.1186/s42494-023-00131-6.
Focal cortical dysplasia (FCD) is a common cause of drug-resistant epilepsy. Electroencephalography (EEG) biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.
We report the case of a 21-year-old female with seizure onset at the age of 9, characterized by left-hand dystonic posturing and impaired awareness, which evolved to bilateral tonic-clonic seizures, evaluated in a neurological referral center in Lima, Peru. During 6-h video-EEG, interictal EEG revealing focal brief potentially ictal rhythmic discharges (BIRDs) over the right frontal central region, lasting less than 10 s. The ictal features were characterized by low-voltage fast activity over the same area. Brain magnetic resonance imaging (MRI) demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe. The patient underwent a lesionectomy guided by electrocorticography, which showed continuous polyspikes. BIRDs showing a brief burst of spikes lasting longer than 0.5 s, were also identified on intraoperative electrocorticography (ECoG) and helped define the extent of resection. The patient obtained an Engel Outcome Class IA at 6 years of follow-up.
The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy. Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.
局灶性皮质发育不良（FCD）是药物难治性癫痫的常见病因。预测术后良好预后的脑电图（EEG）生物标志物对于识别局灶性癫痫患者至关重要。
我们报告一例21岁女性病例，该患者9岁起病，以左手肌张力障碍姿势和意识障碍为特征，后演变为双侧强直阵挛发作，在秘鲁利马的一家神经科转诊中心接受评估。在6小时的视频脑电图检查期间，发作间期脑电图显示右侧额中央区有局灶性短暂潜在发作性节律性放电（BIRDs），持续时间少于10秒。发作期特征表现为同一区域的低电压快速活动。脑磁共振成像（MRI）显示右侧额叶有II型局灶性皮质发育不良的局灶性病变。患者在皮质脑电图引导下进行了病灶切除术，术中显示连续多棘波。术中皮质脑电图（ECoG）还发现了持续时间超过0.5秒的短暂棘波爆发的BIRDs，并有助于确定切除范围。患者在随访6年时获得了Engel预后分级IA级。
ECoG上的非典型BIRDs可作为癫痫患者实现长期无发作预后的预后生物标志物。在有或没有脑MRI病变的发展中国家，尽管资源有限，但仍需要更多报告来推进门诊术前评估。
