皮层高γ振荡对致痫灶的定位价值分析  

Value of cortical high-frequency gamma oscillations with electrocorticography in location of epileptogenic zone

作　　者：练欢 但炜[1] 魏钰 谢延风[1] 石全红[1] 詹彦[1] 孙晓川[1] LIAN Huan;DAN Wei;WEI Yu;XIE Yanfeng;SHI Quanhong;ZHAN Yan;SUN Xiaochuan(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2021年第15期1465-1470,共6页Journal of Third Military Medical University

基　　金：国家临床重点专科建设项目[(2011)170号];重庆市卫生局重点课题(2012-1-008)。

摘　　要：目的通过比较难治性颞叶癫痫患者术中皮层脑电图(electrocorticography, ECoG)中高γ振荡(65~100 Hz)振荡活动与棘尖波在激惹区内外及病灶区、病周区及远离病灶区的出现率及分布特点,探讨皮层高频振荡对致痫灶的定位价值。方法回顾性分析本院2013年1月至2019年1月21例难治性颞叶癫痫患者的术中皮层脑电图,将发作间期癫痫样放电(interictal epileptiform discharges, IEDs)出现的导联定义为激惹区,无IEDs出现的导联定为非激惹区,结合术前影像学检查、术中导航及神经外科医师判断将监测皮层区域分为病灶区、病周区及远离病灶区。比较IEDs(滤波范围:1~30 Hz)和高γ振荡(滤波范围:65~100 Hz)的出现率及分布特点,激惹区内、外高γ振荡的分布及病灶周围高γ振荡的发生率。结果 (1)21例患者IEDs和高γ振荡的总出现率均为100.0%(21/21),IEDs、高γ振荡、Gamma+IEDs的导联数分别为(9.50±2.80)、(8.14±2.93)、(6.60±2.40),经RM单向方差分析,IEDs的导联数显著高于高γ振荡和Gamma+IEDs。(2)激惹区和非激惹区中高γ振荡的导联数分别为(6.60±2.40)、(1.50±1.30),事件率[次/(每导联·s)]分别为(0.42±0.30)、(0.20±0.20),经配对t检验,激惹区大于非激惹区。(3)病灶区、病周区及远离病灶区中高γ振荡事件数分别为(46.00±42.00)、(33.40±32.90)、(8.40±9.40),事件率分别为(0.40±0.30)、(0.37±0.38)、(0.10±0.10)。经两两配对t检验,病灶区及病周区中高γ振荡事件数及事件率差异无统计学意义,病灶区及病周区中高γ振荡30 s事件数及事件率分别显著高于远离病灶区。结论术中ECoG中传统IEDs目前仍是指导癫痫手术切除范围的重要标识,而高γ振荡与棘尖波及病灶具有高度一致性,且对于致痫灶识别比棘尖波更精确。IEDs结合高γ振荡可能具有更高的定位致痫灶价值。Objective To investigate the value of high-gamma oscillations(65~100 Hz)in epileptogenic foci localization by analyzing the intraoperative electrocorticography(ECoG)in patients with refractory temporal lobe epilepsy,along with comparing the occurrence rate and distribution characteristics of high-gamma activity as well as spike wave inside and outside the irritative zone and around the foci.Methods A retrospective analysis was carried out on the intraoperative ECoG data of 21 patients with refractory temporal lobe epilepsy in our hospital from January 2013 to January 2019.The channels with interictal epileptiform discharges(IEDs)were defined as irritated area,and those without IEDs as non-irritated area.Based on the preoperative imaging data,intraoperative navigation combined with neurosurgeon’s judgment,the monitoring cortical area was divided into focal area,perifocal area and the area away from the focus.Then the occurrence rate and distribution characteristics of IEDs(filter range:1~30 Hz)and high-gamma were compared,and the distribution of high-gamma activity inside and outside the irritated area,and the incidence of high-gamma around the foci were analyzed.Results(1)The overall incidence of IEDs and of high-gamma in the 21 patients were both 100.0%(21/21),and the average number of channels for IEDs,high-gamma and gamma+IEDs was 9.50±2.80,8.14±2.93 and 6.60±2.40,respectively,indicating notably more IEDs channels than the other 2,by RM one-way ANOVA(P<0.05).(2)The channel numbers of high-gamma were 6.60±2.40 and 1.50±1.30 in the irritated and non-irritated areas respectively,and the event rates were 0.42±0.30 and 0.20±0.20 respectively,showing significant difference between the 2 areas(P<0.01).(3)The event numbers of high-gamma activity were 46.00±42.00,33.40±32.90 and 8.40±9.40 in the focal area,the perifocal area and the area away from the focus,respectively,with the corresponding event rate of 0.40±0.30,0.37±0.38 and 0.10±0.10,respectively.There were no significant differences in the event n

关 键 词：皮层脑电图 癫痫 棘尖波 高频振荡 致痫灶 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]