Cendes F, Dubeau F, Andermann F, Quesney L F, Gambardella A, Jones-Gotman M, Bizzi J, Olivier A, Gotman J, Arnold D L
Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
Brain. 1996 Aug;119 ( Pt 4):1317-26. doi: 10.1093/brain/119.4.1317.
We studied 31 consecutive patients with temporal and extratemporal epilepsy who underwent presurgical evaluation with stereotaxic depth EEG (SEEG) to assess the relationships between amygdalo-hippocampal (AM-HF) atrophy and the location of SEEG seizure onset and SEEG interictal abnormalities. Scalp EEG recordings with sphenoidal electrodes had shown bitemporal ictal or interictal epileptic abnormalities in all. Patients underwent high quality MRI scans, including MRI volumetric measurements of mesial temporal structures. None had foreign tissue lesions. The final conclusions of the SEEG investigation coincided with the lateralization obtained by MRI volumetric measurements in the eight patients who had significant unilateral atrophy of the amygdala, hippocampus or both (> 2 SD below the mean of controls). In these patients with unilateral atrophy, all or > 75% of clinical seizures originated from the atrophic side. The seven patients with bilateral, but significantly asymmetrical, mesial atrophy had bilateral seizure onsets with > 70% originating from the more atrophic side in four, from the less atrophic side in two, and without predominance in one. The one patient with severe bilateral symmetrical atrophy had seizures originating equally from both sides. Five patients had no atrophy on MRI, but depth electrodes revealed predominant unilateral ictal temporal onsets in four of them. There was no significant correlation between the frequency of SEEG interictal spikes and the amount of AM-HF atrophy. However, we found a significant correlation between the severity of SEEG background disturbance in AM and HF and the degree of atrophy of these structures. Patients with unilateral atrophy were more frequently free of seizures after surgery than those with bilateral or no atrophy (P < 0.05). We conclude that unilateral mesial atrophy predicts ipsilateral mesial SEEG seizure onset despite bitemporal extracranial EEG foci. However, in patients with significant bilateral mesial atrophy, SEEG seizures may originate from either side, even in the presence of significant asymmetry. Finally, the identification of unilateral mesial atrophy has prognostic importance.
我们研究了31例连续性颞叶和颞叶外癫痫患者，这些患者接受了立体定向深部脑电图（SEEG）术前评估，以评估杏仁核-海马（AM-HF）萎缩与SEEG发作起始部位及SEEG发作间期异常之间的关系。所有患者蝶骨电极头皮脑电图记录均显示双侧发作期或发作间期癫痫异常。患者接受了高质量的MRI扫描，包括内侧颞叶结构的MRI容积测量。均无异物组织病变。在8例杏仁核、海马或两者有明显单侧萎缩（低于对照组均值2个标准差以上）的患者中，SEEG检查的最终结论与MRI容积测量得出的定位一致。在这些单侧萎缩的患者中，所有或超过75%的临床发作起源于萎缩侧。7例双侧但明显不对称的内侧萎缩患者有双侧发作起始，其中4例超过70%的发作起源于萎缩更严重侧，2例起源于萎缩较轻侧，1例无优势侧。1例严重双侧对称萎缩患者的发作两侧均等起源。5例MRI无萎缩，但深部电极显示其中4例主要为单侧发作期颞叶起始。SEEG发作间期棘波频率与AM-HF萎缩程度之间无显著相关性。然而，我们发现杏仁核和海马中SEEG背景干扰的严重程度与这些结构的萎缩程度之间存在显著相关性。单侧萎缩患者术后无发作的频率高于双侧或无萎缩患者（P<0.05）。我们得出结论，尽管有双侧颅外脑电图病灶，但单侧内侧萎缩可预测同侧内侧SEEG发作起始。然而，在有明显双侧内侧萎缩的患者中，SEEG发作可能起源于任何一侧，即使存在明显不对称。最后，单侧内侧萎缩的识别具有预后重要性。
