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颅内脑电图对癫痫发作模式的研究对癫痫灶的精确定位和指导成功切除有重要作用。它也引出了癫痫发生机制相关的重要病理生理问题。目前,植入硬膜下和深部电极等记录方式已经描述了几种癫痫发作模式(主要是颞叶癫痫和伴有异质新皮层病变的癫痫)。研究分析了53例患者的连续性队列资料,所有患者均行立体定向脑电图(SEEG)监测,且病理证实为皮质发育畸形(Malformation of cortical development,MCD)——局灶性皮质发育不良(Focal cortical dysplasia,FCD)和神经发育肿瘤(Neurodevelopmental tumors,NDTs)。通过对视觉和时间-频率的分析,证实了存在6种癫痫发作模式:低压快波活动(Low-voltage fast activity,LVFA);发作前棘波继之LVFA;爆发性多棘波继之LVFA;慢波/直流电漂移继之LVFA;θ或α尖波;节律性棘波/棘波。结果表明包含LVFA的模式(83%)普遍性较高,但是LVFA并不是癫痫发作的一个固定特征。癫痫发作模式和组织学类型具有相关性(P=0.01)。更加普遍的模式如下:(1)FCDⅠ型:LVFA占23.1%,慢波/基线漂移继之LVFA占15.4%;(2)FCDⅡ型:爆发性多棘波继之LVFA占31%,LVFA占27.6%;发作前棘波继之LVFA占27.6%;(3)NDTs:LVFA占54.5%。发现包含LVFA的癫痫发作模式与较好的手术预后具有相关性,但癫痫灶切除的完整性是一个独立预测因子;FCD和NDTs有6种不同的癫痫发作模式;包含LVFA的癫痫发作模式的患者手术预后更好。
The study of intracranial electroencephalogram (EEG) on the epileptic seizure model plays an important role in the precise localization of epileptic foci and the successful guiding of the resection. It also elicits important pathophysiological issues related to the mechanism of epilepsy. At present, several epileptic modes (mainly temporal lobe epilepsy and epilepsy with heterogeneous neocortical lesions) have been described by recording methods such as subdural and deep electrodes. The cohort of 53 consecutive patients was analyzed. All patients underwent stereotactic electroencephalography (SEEG) monitoring and the pathology was confirmed as MCD (focal cortical development) Focal cortical dysplasia (FCD) and neurodevelopmental tumors (NDTs). Through the visual and time-frequency analysis, it was confirmed that there are 6 kinds of seizure patterns: low-voltage fast activity (LVFA); pre-attack spikes followed by LVFA; explosive spike followed by LVFA; Slow wave / DC drift followed by LVFA; θ or α spikes; rhythmic spikes / spikes. The results show that LVFA-containing patterns (83%) are more common, but LVFA is not a fixed feature of seizures. There was a correlation between seizure patterns and histological types (P = 0.01). The more common patterns are as follows: (1) FCD type I: LVFA accounted for 23.1%, slow wave / baseline drift followed by LVFA accounted for 15.4%; (2) FCD type II: explosive multisplit wave followed by LVFA accounted for 31%, LVFA accounted for 27.6 %; Spike wave followed by LVFA accounted for 27.6%; (3) NDTs: LVFA accounted for 54.5%. It was found that the pattern of epileptic seizures involving LVFA was associated with a better surgical outcome, but the completeness of the excision of the epileptic foci was an independent predictor; there were 6 different seizure patterns for FCD and NDTs; patients with epileptic seizures involving LVFA The prognosis is better.