立体定向脑电图在结节性硬化症相关难治性癫痫中的定位价值及预后影响因素分析

Localization value of stereoelectroencephalography in refractory epilepsy associated with tuberous sclerosis complex and its prognostic predictors

目的研究立体定向脑电图(SEEG)在结节性硬化症(TSC)相关难治性癫痫中的定位价值, 并分析其预后影响因素。方法病例对照研究。回顾性分析2014年1月至2023年3月在清华大学玉泉医院癫痫中心进行SEEG电极置入的66例TSC相关难治性癫痫患儿资料, 包括病史、发作症状、头皮脑电图、影像学、SEEG。根据手术后有无发作, 将患儿分为无发作组和发作组, 采用t检验、χ^(2)检验比较发病年龄、手术年龄、病程、基因结果、发作症状、头皮脑电图特点、SEEG置入方案与手术预后的关系。结果共66例患儿符合入组标准, 其中55例术后无发作(无发作组), 11例仍有发作(发作组)。66例患儿中, 男46例, 女20例;起病年龄(21.72±30.01)个月;SEEG手术年龄(6.79±5.12)岁;病程(4.98±4.11)年。SEEG结果:发作起始于单结节43例(64.4%), 发作起始于一侧半球内2个及2个以上结节16例, 7例患儿经SEEG监测后为双侧多结节或不能明确起始结节。发现以下因素与预后有关:手术年龄小(t=-3.463, P<0.01)、头皮脑电图发作期有定侧提示(χ^(2)=7.876, P<0.05)、间歇期与发作期脑电图一致性(χ^(2)=6.821, P<0.05)。而起病年龄、病程、发作类型及症状、基因结果、SEEG置入方案与手术预后无明显相关性。SEEG置入后结果发现单结节局灶起源术后效果更好。结论本研究证实了SEEG在TSC相关难治性癫痫中的安全性和有效性, 同时发现发作期脑电图在指导TSC相关难治性癫痫SEEG置入中具有独一无二的价值, 有助于更好地选择哪些TSC相关难治性癫痫患儿适合SEEG置入。

ObjectiveTo study the localization value of stereoelectroencephalography(SEEG)in refractory epilepsy associated with tuberous sclerosis complex(TSC),and to analyze the prognosis related factors.MethodsA case control study.Data of 66 patients with TSC-related refractory epilepsy who underwent SEEG placement at the Epilepsy Center of Tsinghua University Yu-Quan Hospital from January 2014 to March 2023 were retrospectively analyzed,including medical history,seizure semiology,scalp electroencephalogram(EEG),imaging,and SEEG findings.Patients were divided into a seizure-free group and a seizure group according to the seizures after surgery.t/χ^(2) test was used to compare the relationship between age of onset,age of surgery,duration of epilepsy,genetic findings,seizure symptoms,scalp EEG characteristics,SEEG placement protocol and prognosis.ResultsA total of 66 patients met the enrollment criteria,of whom 55 patients were seizure-free after surgery(seizure-free group),and 11 patients still had seizures(seizure group).Among the 66 patients,there were 46 males and 20 females;the age of onset was(21.72±30.01)months;the age of SEEG surgery was(6.79±5.12)years;the duration of epilepsy was(4.98±4.11)years.SEEG results showed that seizures started with a single tuber in 43 patients(64.4%),seizures started with 2 or more tubers in one hemisphere in 16 patients,and 7 patients had bilateral multi-tubers or the pathogenic tuber(s)could not be identified.The following factors were found to be associated with prognosis:early age of surgery(t=-3.463,P<0.01),ictal scalp EEG with a definite lateralization(χ^(2)=7.876,P<0.05),and the concordance of interictal and ictal EEG(χ^(2)=6.821,P<0.05).The age of onset,duration of epilepsy,seizure type and symptom,genetic findings,and SEEG placement protocol were not significantly correlated with prognosis.The results of SEEG identified that onset with a single tuber revealed a better postoperative outcome.ConclusionsThis study confirms the safety and efficacy of SEEG in TSC-related refractory epilepsy,and also finds that ictal EEG is uniquely valuable in guiding SEEG placement for TSC-related refractory epilepsy,which can help us better select patients with TSC-related refractory epilepsy who are suitable for SEEG placement.