Long-term Video-eeg, And Intraoperative Ecog In Epilepsy Surgery

Objective: To analyze the clinical and EEG characteristics seizures and to explore the applicational value of video-EEG (VEEG) and ECoG in the diagnosis and treatment of epilepsy.Methods: The clinical seizure types, preoperative cranial MRI, VEEG findings and intraoperative ECoG and deep electrode EEG monitoring was analyzed retrospectively in 100 patients with epilepsy. Diagnostic Standard:1. Classification of epilepsy: according to the proposal for revised clinical and electroencephalographic classification of epileptic seizures in 1981 and proposal for revised classification of epilepsies and epileptic syndromes in 1989.2. Classification of scalp electroencephalogram: according to the classification in Liu xiaoyan's work: Clinical Electroencephalography.3. Classification of electrocorticogram(ECoG): because there is not a common standard of ECoG, we classified the data according to the spike, this classification was maked by Zhou yanhong.â… (great abnormality):The spike is continuous in one point at least.â…¡(medium abnormality):The spike is paroxysmal;â…¢(low-grade abnormality):The spike is random;â…£(normal):There is no spike.Results:1. Results of classification: Clinical seizure were recorded in 89 patients during continuous VEEG monitoring more than twenty-four hours, including simple partial seizure in 9 patients, complex partial seizures in 57 patients(including partial seizure evolving to generalized tonic-clonic seizures in 20 patients), generalized tonic-clonic seizure in 15 patients,absence seizure in 2 patients and mixed seizure in 6 patients. Classification of epileptic syndromes: temporal lobe epilepsy(TLE)in 54 patients, frontal lobe epilepsy(FLE) in 35patients,occipital lobe epilepsy in 2 patients, parietal lobe epilepsy in 3 patients, poly-source epilepsy in 5 patients, unidentified-source epilepsy in 1 patient. Epileptiform discharges were found in 97 patients and the majority of them were found in temporal lobe and frontal lobe. ECoG monitoring found focal epileptiform discharges in hippocampal region in 18 patients.2. Syndrome: The syndrome of epilepsy is various. The characteristic of TLE: autonomic symptoms or signs and special-sensory symptoms are characteristic of simple partial seizures. Epigastric sensation is common syndrome. Complex partial seizures is often with arrest of action at onset, followed by automatisms, the duration is usually more than 1minutes, and the patients are often with impairment of consciousness after seizures. The syndrome of FLE: Frontal lobe seizures were frequent, brief and nocturnal preponderance. Most seizures occurred during sleep. The common ictal manifestations included hypermotor seizures or complex motor automatisms,head and eye tonic deviation, tonic posturing, vocalization, pseudofrontal absences and so on.3. Analysis of EEG: from interictal stage to ictal stage, each type had their own regular. Compared the results of epileptiform discharges from different angles , the results are as follows: The differents between two hemisphere had no statistics signification. In the group with clinical seizure, the frequency of epileptiform discharges only in sleeping were compared between the group which had clinical seizure just in sleeping and the group which had clinical seizure just in awakening, the results show that the former was higher than the latter (P<0.05). In the same way, FLE was higher than the TLE(P<0.01). The differents between presurgical ECoG and postoperative ECoG had statistics signification(P<0.05).Conclusions: VEEG and ECoG might be of important value in the diagnosis and focus localization of epilepsy.