下丘脑错构瘤患者立体脑电图的特点及预后分析

Stereo-EEG features of hypothalamic hamartoma and prognosis analysis

目的通过研究下丘脑错构瘤(HH)患者立体脑电图(SEEG)的波形特点,探索与发作频率、致痫区定位密切相关的电生理标记物。方法回顾性收集3例行SEEG电极植入的HH患者的病历资料,分析患者皮层和错构瘤记录电极在发作间期、发作前及发作期SEEG的波形特点,并根据致痫区定位手术切除病灶。术后随访患者的头颅核磁共振、头皮脑电图(EEG)及用药情况,以评价SEEG波形对HH患者的定位诊断价值。结果3例患者大脑皮层EEG间歇期放电模式包括阵发性快活动、棘和(或)尖慢波节律及多棘波节律3种。HH的EEG间歇期放电模式包括孤立性棘和(或)尖波、暴发性棘慢波节律、阵发性快活动及类周期样放电节律。类周期样放电是错构瘤最常见的放电模式。2例DelalandeⅠ型的HH患者除有痴笑发作外,还记录到其他发作类型;皮层和错构瘤EEG在发作前期均记录到持续性痫样放电(CED),CED显著区与发作起源脑区一致,其分布指数与发作频率相关。结论发作前期EEG记录到的CED可能是预测HH患者手术疗效的一个重要指标。术前致痫灶定位评估时,结合该指标可能较单独应用发作起始区定位更为准确。

Objective To explore electrophysiological markers closely related to seizure frequency and location of epileptogenic areas by investigating the waveform characteristics of stereo-electroencephalogram(S-EEG)in patients with hypothalamic hamartoma(HH).Methods Medical records were retrospectively collected from 3 patients with HH who underwent S-EEG electrode implantation.The patients'cortexes and HH were analyzed.Waveform characteristics of S-EEG during the inter-,pre-seizure and seizure periods were recorded.The lesions were determined for surgical removal based on the location of the epileptogenic area.Head MRI images,scalp EEG and medications of follow-up patients after surgery were used to evaluate the diagnostic value of S-EEG waveforms in locating epileptogenic foci of the patients with HH.Results The interictal cortical discharge patterns in three patients included paroxysmal fast activity,spike/spike slow wave rhythm and multi-spike rhythm.The interictal cortical discharge patterns in HH exhibited isolated spike and/or sharp waves,explosive spike slow wave rhythm,paroxysmal fast activity and period-like discharge rhythm.Period-like discharge was the most common pattern in hamartomas.Two patients with Delalande type I HH not only had gelastic seizures,but also exhibited other recorded types of seizures.Epileptiform discharge(CED)was recorded in both cortical-and hamartoma-EEG before the onsets.The areas with obvious CED were corresponding to the areas of origin of the seizures.Its distribution index was correlated with seizure frequency.Conclusion CED in preictal EEG may serve as an important predictor of surgical outcome in patients with HH.When assessing the location of epileptic foci before surgery,combining with this indicator may be more accurate than using it alone to locate the onset area of the seizures.