病变性顶叶癫痫患者脑电图特征及与手术疗效关系分析

Analysis of EEG characteristics and relationship with surgical outcome in patients with lesional parietal lobe epilepsy

目的探讨MRI显示有局限顶叶病变的癫痫患者的头皮脑电图特征及与手术疗效的关系。方法回顾性分析2012年1月至2019年12月间收治的行切除性手术治疗且MRI显示为局限顶叶病变的53例癫痫患者头皮脑电图发作间期及发作期表现,并比较不同脑电特征的患者间的手术疗效。结果所有53例患者,发作间期痫样放电分布为:37.7%(20/53)间期正常;17.0%(9/53)仅分布在病变侧顶区;其余45.3%(24/53)分布超出病变侧顶区,其中17.0%(9/53)仅分布在病变侧颞区。24例捕获到临床发作的患者中,37.5%(9/24)发作起源于病变侧顶区;62.5%(15/24)不确定发作起源或起源于其他脑区,其中16.7%(4/24)起源于同侧颞区。术后3例失随访,其余平均随访58.722.0个月,76.0%(38/50)的患者为EngelⅠ级,由于病例数较小,不同脑电特征(间期或发作期)的患者间手术疗效无统计学差异(均有P>0.05)。结论病变性顶叶癫痫患者头皮脑电图定位价值低,甚至有一定的定位误导性,发作期定位价值大于发作间期,不同放电形式和手术疗效无明显相关性。

Objective To investigate the characteristics of scalp EEG and relationship with surgical outcomein patients with lesional parietal lobe epilepsy(PLE).Methods We retrospectively analyzed the interictal and ictal scalp EEG of 53lesional PLE patients admitted from January 2012to December 2019who underwent resective surgical treatment,and compared the surgical outcome of patients with different EEG characteristics.Results In all53patients,the distribution of interictal epileptiform discharges(IEDs)was:37.7%(20/53)had normal interictal EEG;17.0%(9/53)were distributed only in the lesional parietal lobe;the remaining 45.3%(24/53)were distributed beyond the lesional parietal lobe,of which 17.0%(9/53)were distributed only in the ipsilateraltemporal lobe.Of the 24patients with captured clinical seizures,37.5%(9/24)had seizure origins in the lesional parietal lobe;62.5%(15/24)were uncertain or originated in other brain regions,of which 16.7%(4/24)originated in the ipsilateral temporal lobe.3cases were lost to follow-up after surgery,and the remaining were followed up for a mean of 58.722.0months.76.0%(38/50)of the patients were Engel class I.Due to the small number of cases,there was no statistical difference in surgical outcome between patients with different EEG characteristics(interictal or ictal)(all P>0.05).Conclusion The localization value of scalp EEG in patients with lesional PLE is low,and even somewhat misleading in localization,the localization value is greater in the ictal than in the interictal EEG,and there was no significant correlation between different EEG pattern and surgical outcome.