<strong>Objective:</strong> The etiology, clinical manifestations and treatment of 1170 patients with symptomatic epilepsy were retrospectively analyzed and provided guidance for further treatment of sympt...<strong>Objective:</strong> The etiology, clinical manifestations and treatment of 1170 patients with symptomatic epilepsy were retrospectively analyzed and provided guidance for further treatment of symptomatic epilepsy. <strong>Method: </strong>A retrospective analysis of 1170 cases of symptomatic epilepsy admitted to the First Affiliated Hospital of Yangtze University from January 2013 to June 2018 was conducted to analyze the etiology, clinical manifestations and treatment of different age groups.<strong> Results:</strong> Symptomatic epilepsy is high in the elderly, and men are more than women. Among the 1170 patients with symptomatic epilepsy, there were 81 (6.9%) cases of brain injury, 721 (61.6%) cases of cerebrovascular disease, 223 (19.0%) cases of tumor, 59 (5.0%) cases of central nervous system infection, 33 (2.8%) cases of immune metabolic disease, 11 (0.9%) cases of drugs, 6 (0.5%) cases of cortical dysplasia, 6 (0.5%) cases of neurodegenerative disease, 4 (0.3%) cases of parasites, 4 (0.3%) cases of poisons, and 22 (1.9%) cases of other diseases. Among them, central nervous system infection and cerebrovascular disease ranked first among the patients aged 0 - 18 years, followed by immune metabolic diseases;cerebrovascular disease ranked first among the patients aged 19 - 39 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged 40 - 65 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged over 65 years, followed by tumors, among the types of seizures, 74 (6.3%) cases of tonic seizures, 68 (5.8%) cases of clonic seizures, 856 (73.2%) cases of tonic-clonic seizures, 27 (2.3%) cases of myoclonic seizures, 12 (1.0%) cases of absence seizures, 116 (9.9%) cases of complicated partial seizures, and 17 (1.5%) cases of partial seizures, in addition to the etiology, 795 (67.9%) cases of sodium valproate, 152 (13.0%) cases of carbamazepine, 56 (4.8%) cases of topiramate, 117 (10.0%) cases of levetiracetam, 23 (2.0%) cases of lamotrigine, and 27 (2.3%) cases of others were taken. <strong>Conclusion: </strong>In symptomatic epilepsy, different age groups have different causes. Among them, cerebrovascular disease, central nervous system infection, brain trauma, and brain tumor are the main causes. The most common type of seizures is the occurrence of tonic-clonic seizures. The most common drugs are sodium valproate and carbamazepine.展开更多
One hundred patients with focal epilepsy were recruited for the present study and their seizures controlled with antiepileptic drugs. The patients then orally received a capsule of tall gastrodis tuber powder, a tradi...One hundred patients with focal epilepsy were recruited for the present study and their seizures controlled with antiepileptic drugs. The patients then orally received a capsule of tall gastrodis tuber powder, a traditional Chinese drug, and underwent single photon emission computed tomography, long-term electroencephalogram, and CT/MRI. Blood drug levels were monitored throughout the study. Before treatment with tall gastrodis tuber, 35 of the 100 cases had abnormal CT/MRI scans; 79 cases had abnormal single photon emission computed tomography images; 86 cases had abnormal electroencephalogram; and a total of 146 abnormal perfusion foci were observed across the 100 subjects. After treatment, the number of patients with normal single photon emission computed tomography images increased by 12; normal electroencephalogram was observed in an additional 27 cases and the number of patients with epileptiform discharge decreased by 29 （34% of 86）; the total number of abnormal perfusion foci decreased by 52 （36%） and changes in abnormal loci were visible in 65 patients. These changes indicate that the administration of tall gastrodis tuber in combination with antiepileptic drugs repairs abnormal perfusion foci in patients with focal epilepsy Our results demonstrate that traditional Chinese drugs can repair abnormal perfusion foci and, as such, are a promising new pathway in the treatment of focal epilepsy.展开更多
There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and res...There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and resect the epileptogenic lesions responsible for focal epilepsy.This study aims to show the benefit of dedicated epilepsy MRI sequences in the diagnosis of focal epilepsies.A general electric 1.5 Tesla MRI machine was used with standard and special sequences.Also,a Nihon Kohden electroencephalography(EEG)machine was used.This is a prospective observational study that included 51 patients with focal epilepsies who had an initial negative brain imaging.They underwent epilepsy MRI sequences along with a prolonged video EEG monitoring to localize the lesion,and then results were analyzed statistically using SPSS 22 program.The majority of patients were males(62.75%)with a mean age of 30 years.The grand majority of patients(74.5%,p value of 0.001)had their lesion localized by the epilepsy MRI.The most commonly found pathology was mesial temporal sclerosis.A significant number of patients(23.5%)were sent for an epilepsy surgery(p value 0.002).This study shows the significant impact of dedicated epilepsy MRI sequences on the diagnosis and management of focal epilepsy in the Lebanese population.展开更多
Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often ...Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often evolving to loss of consciousness. Scalp EEG-video monitoring showed interictal left temporal slowing and frequent left temporal epileptiform discharges. Three stereotypical complex partial seizures consistent with her habitual attacks were recorded. Two seizures showed a left temporal onset and whereas the third one appeared to start on the right temporal lobe. In patients with paroxysms of abdominal pain, nausea or vomiting, abdominal epilepsy should be considered after exclusion of the most common aetiologies for gastrointestinal conditions.展开更多
Focal epilepsy accounts for 60% of all forms of epilepsy, but the pathogenic mechanism is not well understood. In this study,three novel mutations in NPRL3(nitrogen permease regulator-like 3), c.937_945del, c.1514dup ...Focal epilepsy accounts for 60% of all forms of epilepsy, but the pathogenic mechanism is not well understood. In this study,three novel mutations in NPRL3(nitrogen permease regulator-like 3), c.937_945del, c.1514dup C and 6,706-bp genomic DNA(g DNA) deletion, were identified in three families with focal epilepsy by linkage analysis, whole exome sequencing(WES) and Sanger sequencing. NPRL3 protein is a component of the GATOR1 complex, a major inhibitor of m TOR signaling. These mutations led to truncation of the NPRL3 protein and hampered the binding between NPRL3 and DEPDC5, which is another component of the GATOR1 complex. Consequently, the mutant proteins enhanced m TOR signaling in cultured cells, possibly due to impaired inhibition of m TORC1 by GATOR1. Knockdown of nprl3 in Drosophila resulted in epilepsy-like behavior and abnormal synaptic development. Taken together, these findings expand the genotypic spectrum of NPRL3-associated focal epilepsy and provide further insight into how NPRL3 mutations lead to epilepsy.展开更多
For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection o...For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography(SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation(RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.展开更多
Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally...Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally distributed brain network.Increasing evidence from animal and clinical studies has indicated that focal changes may occur prior to ASs;however,the relationship of ASs with epileptogenic lesions remains unclear.Methods We retrospectively collected and analyzed the clinical,imaging,and electrophysiological data of 16 patients who had ASs and structural lesions with seizure-free outcomes after lesion resection.Results In semiology analysis,nine patients displayed focal onset;only two patients showed simple ASs,and seizure types other than ASs were observed in the remaining patients.On ictal electroencephalography(EEG),four patients showed bilateral synchronous symmetric 3 Hz generalized spike-wave discharges(GSWDs),and the remaining patients showed bilateral 1.5–2.5 Hz GSWDs.Moreover,most patients(13/16,81.3%)exhibited focal features in addition to ASs,while interictal EEG was the same in 12 patients.Furthermore,on stereoelectroencephalogram(SEEG),2/5 patients showed focal discharges before bilateral burst GSWDs.Additionally,all patients had structural lesions on imaging.In four typical AS patients,the lesions were located in deep brain regions.Notably,in 9 patients(9/16,56%),the lesions were located in the posterior cortex.All patients underwent lesion resection and had seizure-free outcomes during follow-up,and intelligence quotient(IQ)also improved by 10.71±3.90 one year after surgery.Conclusions Patients with lesion-related epilepsy may present with ASs that have a focal onset and are associated with good surgical outcomes.展开更多
Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine ...Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.展开更多
目的探讨局灶性癫痫围发作期心率变异性变化特点。方法收集2014年9月至2019年9月在首都医科大学附属北京天坛医院癫痫中心进行术前评估并完成手术的癫痫患者102例,选择局灶性发作198次,手动测量相邻两个心电活动的RR间期,计算心率变异...目的探讨局灶性癫痫围发作期心率变异性变化特点。方法收集2014年9月至2019年9月在首都医科大学附属北京天坛医院癫痫中心进行术前评估并完成手术的癫痫患者102例,选择局灶性发作198次,手动测量相邻两个心电活动的RR间期,计算心率变异性时域参数-相邻正常心跳间期差值平方和的均方根(RMSSD),比较发作前60 s、发作期、终止后60 s RMSSD差异,并比较不同心率变化类型、不同发作类型、不同发作前状态以及不同致痫灶部位和侧别RMSSD差异。结果发作期和发作前60 s及终止后60 s RMSSD相比差异有统计学意义(P<0.001),提示发作期RMSSD降低;心率增快类型癫痫发作期RMSSD降低(P<0.001);复杂部分性癫痫发作期RMSSD降低(P<0.001);颞叶内侧癫痫发作期RMSSD降低(右颞叶内侧P<0.001;左颞叶内侧P<0.001);心率无变化(P=0.556)和心率减慢(P=0.983)类型癫痫发作、单纯部分性癫痫(P=0.869)、颞叶外侧癫痫(右颞叶外侧P=0.204;左颞叶外侧P=0.849)和颞叶外癫痫(右颞外P=0.188;左颞外P=0.068)发作期RMSSD无降低。发作期和发作前60 s RMSSD差值在睡眠期更明显(P=0.039)。结论心率增快类型癫痫发作、复杂部分性癫痫、颞叶内侧癫痫发作期易发生心率变异性下降,提示癫痫发作期副交感活性下降;睡眠期状态下发生的癫痫发作期心率变异性下降相比清醒期显著,提示睡眠期癫痫发作副交感活性下降更加明显。展开更多
Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoper...Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.展开更多
The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the effects of them on the EEG activity of epileptic patients have been scarcely studied. Eslicarbazepine is a third generat...The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the effects of them on the EEG activity of epileptic patients have been scarcely studied. Eslicarbazepine is a third generation blocker-sodium channels AED associated with a high reduction in the rate of partial seizures in epileptic patients. We designed an open label, non control study to determine the effects of Eslicarbazepine on the EEG activity of EP with focal seizures in a 12-week follow up. The EP with focal paroxystical activity enrolled in this study showed a statistical significant reduction in the rate of monthly seizures when Eslicarbazepine 800 mgs was added to a previous AED compared to those patients who only received an increase of the AED in monotherapy, concomitantly, EP treated with ESL added to a previous AED showed a statistically significant reduction in the mean occipital frequency and voltage amplitude in the central and parietal regions in the twelfth-week EEG compared to the control group.展开更多
文摘<strong>Objective:</strong> The etiology, clinical manifestations and treatment of 1170 patients with symptomatic epilepsy were retrospectively analyzed and provided guidance for further treatment of symptomatic epilepsy. <strong>Method: </strong>A retrospective analysis of 1170 cases of symptomatic epilepsy admitted to the First Affiliated Hospital of Yangtze University from January 2013 to June 2018 was conducted to analyze the etiology, clinical manifestations and treatment of different age groups.<strong> Results:</strong> Symptomatic epilepsy is high in the elderly, and men are more than women. Among the 1170 patients with symptomatic epilepsy, there were 81 (6.9%) cases of brain injury, 721 (61.6%) cases of cerebrovascular disease, 223 (19.0%) cases of tumor, 59 (5.0%) cases of central nervous system infection, 33 (2.8%) cases of immune metabolic disease, 11 (0.9%) cases of drugs, 6 (0.5%) cases of cortical dysplasia, 6 (0.5%) cases of neurodegenerative disease, 4 (0.3%) cases of parasites, 4 (0.3%) cases of poisons, and 22 (1.9%) cases of other diseases. Among them, central nervous system infection and cerebrovascular disease ranked first among the patients aged 0 - 18 years, followed by immune metabolic diseases;cerebrovascular disease ranked first among the patients aged 19 - 39 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged 40 - 65 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged over 65 years, followed by tumors, among the types of seizures, 74 (6.3%) cases of tonic seizures, 68 (5.8%) cases of clonic seizures, 856 (73.2%) cases of tonic-clonic seizures, 27 (2.3%) cases of myoclonic seizures, 12 (1.0%) cases of absence seizures, 116 (9.9%) cases of complicated partial seizures, and 17 (1.5%) cases of partial seizures, in addition to the etiology, 795 (67.9%) cases of sodium valproate, 152 (13.0%) cases of carbamazepine, 56 (4.8%) cases of topiramate, 117 (10.0%) cases of levetiracetam, 23 (2.0%) cases of lamotrigine, and 27 (2.3%) cases of others were taken. <strong>Conclusion: </strong>In symptomatic epilepsy, different age groups have different causes. Among them, cerebrovascular disease, central nervous system infection, brain trauma, and brain tumor are the main causes. The most common type of seizures is the occurrence of tonic-clonic seizures. The most common drugs are sodium valproate and carbamazepine.
基金funded by the Key Project of Gansu Province, No.2GS054-A43-014-19
文摘One hundred patients with focal epilepsy were recruited for the present study and their seizures controlled with antiepileptic drugs. The patients then orally received a capsule of tall gastrodis tuber powder, a traditional Chinese drug, and underwent single photon emission computed tomography, long-term electroencephalogram, and CT/MRI. Blood drug levels were monitored throughout the study. Before treatment with tall gastrodis tuber, 35 of the 100 cases had abnormal CT/MRI scans; 79 cases had abnormal single photon emission computed tomography images; 86 cases had abnormal electroencephalogram; and a total of 146 abnormal perfusion foci were observed across the 100 subjects. After treatment, the number of patients with normal single photon emission computed tomography images increased by 12; normal electroencephalogram was observed in an additional 27 cases and the number of patients with epileptiform discharge decreased by 29 （34% of 86）; the total number of abnormal perfusion foci decreased by 52 （36%） and changes in abnormal loci were visible in 65 patients. These changes indicate that the administration of tall gastrodis tuber in combination with antiepileptic drugs repairs abnormal perfusion foci in patients with focal epilepsy Our results demonstrate that traditional Chinese drugs can repair abnormal perfusion foci and, as such, are a promising new pathway in the treatment of focal epilepsy.
文摘There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and resect the epileptogenic lesions responsible for focal epilepsy.This study aims to show the benefit of dedicated epilepsy MRI sequences in the diagnosis of focal epilepsies.A general electric 1.5 Tesla MRI machine was used with standard and special sequences.Also,a Nihon Kohden electroencephalography(EEG)machine was used.This is a prospective observational study that included 51 patients with focal epilepsies who had an initial negative brain imaging.They underwent epilepsy MRI sequences along with a prolonged video EEG monitoring to localize the lesion,and then results were analyzed statistically using SPSS 22 program.The majority of patients were males(62.75%)with a mean age of 30 years.The grand majority of patients(74.5%,p value of 0.001)had their lesion localized by the epilepsy MRI.The most commonly found pathology was mesial temporal sclerosis.A significant number of patients(23.5%)were sent for an epilepsy surgery(p value 0.002).This study shows the significant impact of dedicated epilepsy MRI sequences on the diagnosis and management of focal epilepsy in the Lebanese population.
文摘Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often evolving to loss of consciousness. Scalp EEG-video monitoring showed interictal left temporal slowing and frequent left temporal epileptiform discharges. Three stereotypical complex partial seizures consistent with her habitual attacks were recorded. Two seizures showed a left temporal onset and whereas the third one appeared to start on the right temporal lobe. In patients with paroxysms of abdominal pain, nausea or vomiting, abdominal epilepsy should be considered after exclusion of the most common aetiologies for gastrointestinal conditions.
基金supported by the National Natural Science Foundation of China (32270663, 31871262, U20A20355,32022035)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)the Ministry of Science and Technology of China STI2030-Major Projects (2021ZD0203202)。
文摘Focal epilepsy accounts for 60% of all forms of epilepsy, but the pathogenic mechanism is not well understood. In this study,three novel mutations in NPRL3(nitrogen permease regulator-like 3), c.937_945del, c.1514dup C and 6,706-bp genomic DNA(g DNA) deletion, were identified in three families with focal epilepsy by linkage analysis, whole exome sequencing(WES) and Sanger sequencing. NPRL3 protein is a component of the GATOR1 complex, a major inhibitor of m TOR signaling. These mutations led to truncation of the NPRL3 protein and hampered the binding between NPRL3 and DEPDC5, which is another component of the GATOR1 complex. Consequently, the mutant proteins enhanced m TOR signaling in cultured cells, possibly due to impaired inhibition of m TORC1 by GATOR1. Knockdown of nprl3 in Drosophila resulted in epilepsy-like behavior and abnormal synaptic development. Taken together, these findings expand the genotypic spectrum of NPRL3-associated focal epilepsy and provide further insight into how NPRL3 mutations lead to epilepsy.
基金Supported by Tsinghua University Initiative Scientific Research Program(No.2015THZ01)
文摘For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography(SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation(RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.
基金The National Natural Science Foundation of China supported this work(82171448,82201613).
文摘Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally distributed brain network.Increasing evidence from animal and clinical studies has indicated that focal changes may occur prior to ASs;however,the relationship of ASs with epileptogenic lesions remains unclear.Methods We retrospectively collected and analyzed the clinical,imaging,and electrophysiological data of 16 patients who had ASs and structural lesions with seizure-free outcomes after lesion resection.Results In semiology analysis,nine patients displayed focal onset;only two patients showed simple ASs,and seizure types other than ASs were observed in the remaining patients.On ictal electroencephalography(EEG),four patients showed bilateral synchronous symmetric 3 Hz generalized spike-wave discharges(GSWDs),and the remaining patients showed bilateral 1.5–2.5 Hz GSWDs.Moreover,most patients(13/16,81.3%)exhibited focal features in addition to ASs,while interictal EEG was the same in 12 patients.Furthermore,on stereoelectroencephalogram(SEEG),2/5 patients showed focal discharges before bilateral burst GSWDs.Additionally,all patients had structural lesions on imaging.In four typical AS patients,the lesions were located in deep brain regions.Notably,in 9 patients(9/16,56%),the lesions were located in the posterior cortex.All patients underwent lesion resection and had seizure-free outcomes during follow-up,and intelligence quotient(IQ)also improved by 10.71±3.90 one year after surgery.Conclusions Patients with lesion-related epilepsy may present with ASs that have a focal onset and are associated with good surgical outcomes.
基金This work was supported by the National Key R&D Program of China(No.2022YFC2503800)the National Natural Science Foundation of China(No.82071454)Beijing Municipal Science&Technology Commission(No.Z211100002921032).
文摘Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.
文摘目的探讨局灶性癫痫围发作期心率变异性变化特点。方法收集2014年9月至2019年9月在首都医科大学附属北京天坛医院癫痫中心进行术前评估并完成手术的癫痫患者102例,选择局灶性发作198次,手动测量相邻两个心电活动的RR间期,计算心率变异性时域参数-相邻正常心跳间期差值平方和的均方根(RMSSD),比较发作前60 s、发作期、终止后60 s RMSSD差异,并比较不同心率变化类型、不同发作类型、不同发作前状态以及不同致痫灶部位和侧别RMSSD差异。结果发作期和发作前60 s及终止后60 s RMSSD相比差异有统计学意义(P<0.001),提示发作期RMSSD降低;心率增快类型癫痫发作期RMSSD降低(P<0.001);复杂部分性癫痫发作期RMSSD降低(P<0.001);颞叶内侧癫痫发作期RMSSD降低(右颞叶内侧P<0.001;左颞叶内侧P<0.001);心率无变化(P=0.556)和心率减慢(P=0.983)类型癫痫发作、单纯部分性癫痫(P=0.869)、颞叶外侧癫痫(右颞叶外侧P=0.204;左颞叶外侧P=0.849)和颞叶外癫痫(右颞外P=0.188;左颞外P=0.068)发作期RMSSD无降低。发作期和发作前60 s RMSSD差值在睡眠期更明显(P=0.039)。结论心率增快类型癫痫发作、复杂部分性癫痫、颞叶内侧癫痫发作期易发生心率变异性下降,提示癫痫发作期副交感活性下降;睡眠期状态下发生的癫痫发作期心率变异性下降相比清醒期显著,提示睡眠期癫痫发作副交感活性下降更加明显。
文摘Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against Epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.
文摘The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the effects of them on the EEG activity of epileptic patients have been scarcely studied. Eslicarbazepine is a third generation blocker-sodium channels AED associated with a high reduction in the rate of partial seizures in epileptic patients. We designed an open label, non control study to determine the effects of Eslicarbazepine on the EEG activity of EP with focal seizures in a 12-week follow up. The EP with focal paroxystical activity enrolled in this study showed a statistical significant reduction in the rate of monthly seizures when Eslicarbazepine 800 mgs was added to a previous AED compared to those patients who only received an increase of the AED in monotherapy, concomitantly, EP treated with ESL added to a previous AED showed a statistically significant reduction in the mean occipital frequency and voltage amplitude in the central and parietal regions in the twelfth-week EEG compared to the control group.
