Fiol M E, Gates J R, Mireles R, Maxwell R E, Erickson D M
Department of Neurology, University of Minnesota, Minneapolis.
Epilepsia. 1993 Jan-Feb;34(1):74-8. doi: 10.1111/j.1528-1157.1993.tb02378.x.
The intraoperative transformation of generalized epileptiform discharges (GED) to lateralized epileptiform activity during the course of corpus callosum sectioning for intractable epilepsy in 37 patients was correlated with percentage of decrease in atonic-tonic seizures with "drops" at mean follow-up of 26 months (range 12-86 months). Twenty-seven (73%) patients had intraoperative interictal discharges, and 21 (78%) showed varying degrees of lateralization of GED during corpus callosum sectioning (two thirds to total). All patients experienced > 80% reduction in atonic-tonic seizures with drops. The group (n = 7) with largest decrease in GED had the greatest decrease in seizures (95.5%). Six patients without change in GED had 88% decrease in seizures, as did 14 patients (85-86%) with mild or moderate decreases in GED, but there was no statistically significant correlation between decrease in GED and seizure frequency after operation. Thus, although lateralization of GED after corpus callosum sectioning was evident in 78% of patients with GED, the degree of lateralization of GED did not correlate with degree of reduction of tonic-atonic seizures. Therefore, intraoperative surface EEG monitoring does not appear to be helpful at this time as a guide to extent of callosotomy.
在37例顽固性癫痫患者行胼胝体切开术过程中，全身性癫痫样放电（GED）向局限性癫痫样活动的术中转变，与平均随访26个月（范围12 - 86个月）时失张力 - 强直发作伴“跌倒”次数减少的百分比相关。27例（73%）患者术中出现发作间期放电，21例（78%）在胼胝体切开术期间GED出现不同程度的局限化（三分之二至全部）。所有患者失张力 - 强直发作伴跌倒次数减少>80%。GED减少最多的组（n = 7）癫痫发作减少最多（95.5%）。6例GED无变化的患者癫痫发作减少88%，14例GED轻度或中度减少的患者（85 - 86%）也是如此，但GED减少与术后癫痫发作频率之间无统计学显著相关性。因此，尽管78%有GED的患者在胼胝体切开术后GED出现局限化，但GED的局限化程度与强直 - 失张力发作减少程度无关。所以，目前术中头皮脑电图监测似乎无助于指导胼胝体切开术的范围。
