头皮脑电图在局灶性皮质发育不良所致难治性癫痫中的定位及定侧价值  

Localizing and lateralizing values of the scalp electroencephalogram in patients of epilepsy caused by focal cortical dysplasia

作　　者：王圣松 万慧娟 胡文瀚[3] 王秀[4] 张弨[4] 郑重[5] 桑林[5] 张凯[4] 张建国[3,4] 邵晓秋[1] Wang Shengsong;Wan Huijuan;Hu Wenhan;Wang Xiu;Zhang Chao;Zheng Zhong;Sang Lin;Zhang Kai;Zhang Jianguo;Shao Xiaoqiu(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,First Affiliated Hospital,Xiamen University,Xiamen 361003,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Fengtai Hospital,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京100070 [2]厦门大学附属第一医院神经内科,厦门361003 [3]首都医科大学,北京市神经外科研究所,北京100070 [4]首都医科大学附属北京天坛医院神经外科,北京100070 [5]北京丰台医院神经外科,北京100070

出　　处：《中华神经外科杂志》2022年第9期916-921,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨局灶性皮质发育不良(FCD)所致难治性癫痫患者头皮脑电图(EEG)发作间期和发作期波形的定位和定侧价值。方法回顾性分析2015年1月至2019年12月首都医科大学附属北京天坛医院-北京丰台医院癫痫中心医疗联盟连续收治的171例难治性癫痫患者的临床资料。所有患者术前均行头皮EEG和头颅MRI检查,并进行症状学分析。患者均行癫痫灶切除术,术后采用Engel分级量表评估疗效。根据手术结果计算术前头皮EEG发作间期及发作期的不同波形模式对致痫区的正确定位率和正确定侧率,并与MRI、症状学的正确定位率和正确定侧率进行比较。结果171例均顺利实施癫痫灶切除手术,术后病理均证实为FCD,其中FCDⅠ型30例(17.6%),Ⅱ型90例(52.6%),Ⅲ型51例(29.8%)。头皮EEG发作间期反复放电模式的正确定位率为70.7%(53/75),在同一位置存在单个尖波/棘波或单个慢波合并FCD特征波形模式对致痫区的正确定位率分别为71.9%(46/64)和75.0%(12/16),均高于发作期低波幅快活动起始模式(68.0%,34/50);除了单个尖波/棘波外,头皮EEG其他波形的正确定位率均高于症状学和MRI。MRI阳性组中,MRI的正确定位率与头皮EEG类似。头皮EEG发作期波形对致痫区的正确定侧率均高于发作间期;症状学和MRI的正确定侧率均低于头皮EEG。171例患者的中位随访时间为48个月(30~62个月),所有患者末次随访时Engel分级均为Ⅰ级。结论在FCD所致难治性癫痫患者的术前无创评估中,头皮EEG发作间期和发作期波形模式的正确定位率和定侧率高。分析术前头皮EEG有助于提高术中切除致痫灶的精准度。Objective To explore the localizing and lateralizing values of interictal and ictal scalp electroencephalogram(EEG)patterns in patients with epilepsy caused by focal cortical dysplasia(FCD).Methods We retrospectively selected consecutive 171 patients who had undergone resective epilepsy operations at the Medical Alliance of Epilepsy Center of Beijing Tiantan-Fengtai Hospital between January 2015 and December 2019.All patients underwent preoperative EEG and MRI,and semiology analyses were performed.Thereafter,all patients underwent resective epilepsy surgery,and their outcomes were classified according to the Engel classification scheme.According to the postoperative outcomes,the correct localization and lateralization rates of interictal and ictal scalp EEG patterns for the epileptogenic zone were analyzed and further compared with MRI and semiology results.Results All surgeries were uneventful for 171 cases.Histopathology of brain tissues confirmed FCD typeⅠin 30 cases(17.6%),FCD typeⅡin 90 cases(52.6%),and FCD typeⅢin 51 cases(29.8%).The correct localization rate based on the pattern of repetitive discharges during the interictal scalp EEG was 70.7%(53/75).The correct localization rate based on the pattern of the coexistence of a single discharge(slow wave or sharp wave/spike)and any characteristic FCD waveforms in the same location was 71.9%(46/64)and 75.0%(12/16),respectively,which were both higher than that based on the pattern of ictal low-voltage fast activity onset(68.0%,34/50).The correct localization rates of scalp EEG patterns,except for single sharp wave/spike,were higher than those of semiology and MRI.In the MRI-positive subgroup,the correct localization rate of MRI was similar to that of scalp EEG.The correct lateralization rate of ictal scalp EEG was higher than that of interictal scalp EEG.The correct lateralization rate of semiology and MRI remained lower than that of scalp EEG.The median follow-up time of 171 patients was 48 months(30-62 months),and all patients had the outcome of Engel g

关 键 词：局灶性皮质发育不良 癫痫 脑电图 术前评估 

分 类 号：R742.1[医药卫生—神经病学与精神病学]