Otsubo H, Steinlin M, Hwang P A, Sharma R, Jay V, Becker L E, Hoffman H J, Blaser S
Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Neurol. 1997 Jan;16(1):23-31. doi: 10.1016/s0887-8994(96)00254-8.
Most epileptiform abnormalities show a negative polarity on EEG. Focal positive spike waves have rarely been identified in seizure disorders and are generally associated with physiological and neurological impairment. Results of EEG, computed tomography, MRI, and pathologic studies of 15 children with focal neuronal migration disorders who underwent surgery for refractory localization-related epilepsy were compared to examine the association between positive discharges and other findings. Subjects were studied both ictally and interictally by scalp EEG with the International 10-20 system and zygomatic or sphenoidal electrodes, and video EEG telemetry. The 5 children with positive discharges were significantly more likely to develop hemiparesis during the preoperative period (P < or = .025). Correlations were observed between positive discharges and lesions apparent on MRI situated around the rolandic fissure (P < or = .025). Children with positive discharges had a significantly less favorable outcome after surgical treatment (P < or = .025). Positive epilepti-form discharges in children with neuronal migration disorders may signal a more dysfunctional cortex leading to a focal neurological deficit or a more extended lesion than is detected on MRI. This would explain the less favorable outcome of seizures after surgery, since the epileptogenic areas and neuronal migration lesions cannot be completely resected.
大多数癫痫样异常在脑电图上显示负极性。局灶性正棘波在癫痫发作性疾病中很少被发现，通常与生理和神经功能损害有关。比较了15例因难治性定位相关癫痫接受手术治疗的局灶性神经元移行障碍患儿的脑电图、计算机断层扫描、磁共振成像和病理研究结果，以检查正放电与其他发现之间的关联。通过国际10-20系统头皮脑电图以及颧部或蝶骨电极和视频脑电图遥测技术，对受试者进行发作期和发作间期研究。5例有正放电的患儿在术前更易出现偏瘫（P≤0.025）。观察到正放电与磁共振成像上位于中央沟周围的病变之间存在相关性（P≤0.025）。有正放电的患儿手术治疗后的预后明显较差（P≤0.025）。神经元移行障碍患儿的正癫痫样放电可能表明皮质功能障碍更严重，导致局灶性神经功能缺损或病变范围比磁共振成像检测到的更大。这可以解释手术后癫痫发作预后较差的原因，因为致痫区域和神经元移行病变无法完全切除。
