Adelson P D, O'Rourke D K, Albright A L
Division of Pediatric Neurosourgery, Children's Hospital of Pittsburgh, Pennsylvania, USA.
Neurosurg Clin N Am. 1995 Jul;6(3):491-504.
In both children and adults, it has been well established that the precise localization of a seizure focus allows for the best possible resection and outcome. Long-term invasive monitoring with DE has been the most widely used modality to evaluate patients with intractable seizures of temporal lobe origin. The study of epilepsy in children, however, requires assessment of the cause of the seizures with a resultant decision regarding the optimal modality of study for the particular problem. Complex partial seizures of medial temporal lobe origin without clear concordance or lateralizing information are best studied using DE. With MR imaging anatomic localization, stereotactic insertion of DE can be performed accurately and relatively safely. The information obtained permits lateralization and focus localization if the lesion is within the medial structures. The ability of DE to study epilepsy outside of the medial temporal lobe, however, is suboptimal. Many centers have used surface electrodes to map temporal lobe foci successfully. SE and SGE have not been widely used in children. Subdural electrode arrays, however, are superior to DE in extratemporal epilepsy because the cortical surface contacts provide the best recordings of epileptiform activity from a wide range of extratemporal regions. The limitations of intraoperative ECoG in the awake child are well understood. It is rare that a child can undergo surgery under local anesthesia and cooperate to the extent necessary for definitive mapping of the seizure focus and eloquent areas. Thus, invasive long-term monitoring would seem ideal in the epileptic pediatric patient because it allows for a more relaxed pace in which to record events, and because of the indwelling nature of these electrodes, it is possible for the investigator to map eloquent areas of the brain before resection. This type of evaluation completely and accurately maps interictal and ictal activity, and through cortical stimulation or mapping of somatosensory areas by evoked potentials, eloquent areas of the brain, such as motor and speech regions, can be identified. This method is limited to older children because the young child often has inadequate cortical development to localize these areas definitively. One should note that in young children (under the age of 4 years), the absence of a response to standard cortical stimulation does not indicate nonfunctional cortex. Long-term intractable seizures and significant antiepileptic drug requirements may contribute to developmental and psychosocial deficiencies in the epileptic patient.(ABSTRACT TRUNCATED AT 400 WORDS)
在儿童和成人中，癫痫发作灶的精确定位有利于实现最佳切除效果和预后，这一点已得到充分证实。长期使用深部电极（DE）进行侵入性监测是评估颞叶起源的顽固性癫痫患者最广泛使用的方法。然而，儿童癫痫的研究需要评估癫痫发作的原因，并据此决定针对特定问题的最佳研究方法。对于起源于内侧颞叶且无明确一致性或定位信息的复杂部分性癫痫发作，使用深部电极进行研究最为合适。借助磁共振成像（MR）进行解剖定位后，可准确且相对安全地进行深部电极的立体定向插入。如果病变位于内侧结构内，所获得的信息可实现癫痫灶的定位和定侧。然而，深部电极研究内侧颞叶以外癫痫的能力欠佳。许多中心已成功使用头皮电极来定位颞叶癫痫灶。硬膜下电极（SE）和立体定向脑电图（SGE）在儿童中尚未广泛应用。不过，在颞叶外癫痫中，硬膜下电极阵列优于深部电极，因为皮质表面接触能从广泛的颞叶外区域提供癫痫样活动的最佳记录。清醒儿童术中皮层脑电图（ECoG）的局限性已为人熟知。儿童很少能在局部麻醉下接受手术并配合到足以明确癫痫发作灶和明确功能区所需的程度。因此，侵入性长期监测对于癫痫患儿似乎是理想的选择，因为它能以更宽松的节奏记录事件，而且由于这些电极的留置特性，研究人员有可能在切除前绘制出大脑的明确功能区。这种评估方式能完整、准确地绘制发作间期和发作期活动图，并且通过皮质刺激或诱发电位对体感区进行映射，可识别大脑的明确功能区，如运动区和语言区。这种方法仅限于年龄较大的儿童，因为幼儿的皮质发育往往不足以明确地定位这些区域。需要注意的是，在幼儿（4岁以下）中，对标准皮质刺激无反应并不表明皮质无功能。长期顽固性癫痫发作和大量抗癫痫药物需求可能导致癫痫患者出现发育和心理社会方面的缺陷。（摘要截断于400字）
