药物难治性癫痫患者不同觉醒状态下高频振荡的分布及其对致痫区的定位作用  

Distribution characteristics and clinical implications of high-frequency oscillations in awake and sleep states for identification of epileptogenic zone in drug-resistant epilepsy patients

作　　者：赵学敏[1] 赵宝田[2] 张凯[2] 张弨[2] 邵晓秋[3] 胡文瀚[1] 陶晓蓉 张建国[2] 乔慧[1] Zhao Xuemin;Zhao Baotian;Zhang Kai;Zhang Chao;Shao Xiaoqiu;Hu Wenhan;Tao Xiaorong;Zhang Jianguo;Qiao Hui(Beijing Neurosurgical Institute,Capital Medical University,Bejing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [3]首都医科大学附属北京天坛医院神经内科,北京100070

出　　处：《中华神经外科杂志》2024年第3期230-235,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金青年项目(82201600)。

摘　　要：目的 探讨不同觉醒状态下高频振荡(HFO)的分布特点,明确其与致痫区的关系.方法 前瞻性纳入2023年1-6月首都医科大学附属北京天坛医院神经外科学中心收治的药物难治性癫痫患者.所有患者均行立体脑电图(SEEG)监测,分别选取清醒期及非快速动眼睡眠期(NREM)的发作间期脑电图,通过自动检测算法进行HFO分析,分为涟波(R)和快速涟波(FR).对比分析发作起始区(SOZ)及非SOZ区清醒及睡眠状态的HFO发放频次和HFO高发放导联数目的差异,同时观察HFO的空间分布与致痫区的关系.结果 共纳入17例患者,置入电极数量为(11.6±0.5)根(8~14根),有效导联数量为(100.1±4.2)个,SOZ导联数量为(18.0±2.2)个.与非SOZ区比较,SOZ区R发放频次在清醒[分别为(6.93±1.35)次/min、(1.63±0.41)次/min]及睡眠[分别为(12.13±1.65)次/min、(3.52±0.75)次/min]状态下均明显增高,差异均有统计学意义(均P<0.01);SOZ区FR发放频次在清醒[分别为(5.29±1.92)次/min、(0.14±0.03)次/min]及睡眠[分别为(6.05±1.71)次/min、(0.30±0.07)次/min]状态下,也均明显高于非SOZ区(均P<0.05).进一步分析上述数据显示,睡眠期HFO发放频次总体高于清醒期.在SOZ区,睡眠期R发放频次明显高于清醒期(P<0.001),而FR发放频次增加不明显(P=0.613);在非SOZ区,R及FR发放频次均为睡眠期高于清醒期,差异均有统计学意义(均P<0.05).与清醒期比较,睡眠期R[分别为(13.06± 2.27)个、(4.59±0.21)个]及FR[分别为(9.88±1.70)个、(4.59±0.21)个]的高发放导联数量均明显增多,差异均有统计学意义(均P<0.01).SOZ区导联R在清醒期有(67.4±5.5)%分布于HFO分布区,睡眠期为(69.8±5.8)%;FR则分别为(68.1±5.8)%、(71.1±5.6)%,清醒及睡眠状态下,SOZ区HFO稳定发放.结论 SEEG监测显示,药物难治性癫痫患者在睡眠期HFO发放频次明显高于清醒期,睡眠期HFO分布范围明显增加,清醒及睡眠状态下,SOZ区导联多为HFO高发放导联;清醒期与睡眠�Objective To explore the distribution characteristics of high-frequency oscillations(HFOs)in different wakefulness states and to clarify their relationship to the epileptogenic zone.Methods A prospective inclusion of drug-resistant epilepsy patients treated at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from January to June 2023.All patients underwent stereo-electroencephalogram(SEEG)monitoring.EEG recordings during wakefulness and non-rapid eye movement sleep(NREM)interictal periods were selected.HFO analysis was conducted using an automatic detection algorithm,classifying them into ripple(R)and fast ripple(FR).A comparative analysis of HFO discharge frequency and the number of high HFO discharge electrodes in the seizure onset zone(SOZ)and non-SOZ during wakefulness and sleep states was performed.Additionally,the spatial distribution of HFO and its relationship with the epileptogenic zone were observed.Results A total of 17 patients were included,with an average of 11.6±0.5 electrodes implanted(range:8-14),100.1±4.2 effective contacts,and 18.0±2.2 SOZ contacts.Compared with that in the non-SOZ area,the frequency of R discharges in the SOZ during wakefulness(6.93±1.35 times/min vs.1.63±0.41 times/min)and sleep(12.13±1.65 times/min vs.3.52±0.75 times/min)was significantly higher,with statistically significant differences(both P<0.01).The frequency of FR discharges in the SOZ during wakefulness(5.29±1.92 times/min vs.0.14±0.03 times/min)and sleep(6.05±1.71 times/min vs.0.30±0.07 times/min)was also significantly higher than in the non-SOZ area(both P<0.05).The data above showed that the frequency of HFO discharges during sleep was generally higher than during wakefulness.In the SOZ,the frequency of R discharges during sleep was significantly higher than during wakefulness(P<0.001),while the increase in FR discharge frequency was not significant(P=0.613).In the non-SOZ area,the frequencies of R and FR discharges during wakefulness and sleep were both increased with signific

关 键 词：耐药性癫痫 立体脑电图 高频振荡 发作起始区 定位 

分 类 号：R742.1[医药卫生—神经病学与精神病学]