| Objective: The study of Stereoelectroencephalography(SEEG)seizure-onset patterns(SOP)is crucial to accurately define the epileptogenic zone,guide successful surgical resection and control epileptic seizures in temporal lobe epilepsy(TLE).It also raises important pathophysiologic issues concerning mechanisms of seizure generation.In this study,multi-modal preoperative accurate evaluation was used to investigate the relationship between SEEG seizure-onset patterns and seizure site,imaging findings,etiology type and prognosis in patients with intractable TLE.To further explore the epilepsy control status of patients with TLE after surgery,and evaluate the influence of different factors on prognosis.Data and Methods: The clinical data of 34 patients with TLE who underwent accurate evaluation of multimodal epilepsy surgical evaluation system and received deep intracranial electrode implantation in the Department of Neurosurgery,the Second Hospital of Lanzhou University from January 2018 to December 2021 were analyzed and studied.SEEG interictal and ictal data were analyzed independently by three epilepsy specialists to determine SOPs.Combined with high frequency oscillation,direct current drift and epileptogenic index,the location of seizure onset zone and epileptogenic zone and the analysis of related epileptogenic networks were assisted,and then individualized surgical treatment was performed.In this study,SOPs were classified to analyze theirs relationship with seizure site,imaging findings,etiology and prognosis.To further explore the epileptic control status of patients with TLE after surgery,and to evaluate the influence of different factors on prognosis.The prognosis of epilepsy was evaluated by Engel grading,with Engel Ⅰ indicating good prognosis and Engel Ⅱ-Ⅳ indicating poor prognosis.Results: There were 34 patients enrolled in this study,including 21 males(61.8%)and 13 females(38.2%).The average follow-up was(32.4±14.7)months.In the preoperative epileptic sequence MRI examination,22 cases cases had focal abnormal MRI signals and 12 cases had non-focal abnormal MRI signals.Interictal PET-CT examination showed different degrees of metabolic abnormalities in the brain regions of 34 patients,including 9 patients with single focus and 25 patients with multiple focus.There were 270 electrodes implanted in 34 patients,with an average of(7.94±1.84)electrodes per patient.The total number of electrode contacts was 3326,with an average of(97.82±21.93)contacts in each patient.We analyzed 220 seizures from 34 consecutive patients with TLE.We used a reproducible method combining visual and time‐frequency analyses and described five SOPs: Low-voltage fast activity,high-amplitude low-frequency periodic spikes,spike-and-wave activity,rhythmic sharp activity at ≤13Hz,burst of high-amplitude polyspikes.Combined with postoperative pathological and imaging findings,the etiology was divided into 5categories: 15 cases(44.2%)of focal cortical dysplasia,5 cases(14.7%)of embryonic dysplasia neuroepithelial tumor,5 cases(14.7%)of cerebrovascular disease related epilepsy,3 cases(8.8%)of gray matter heterotopia,and 6 cases(17.6%)of other etiology.Follow-up results were divided into the following groups: 24 patients(70.6%)with good prognosis group(Engel Ⅰ)and 10 patients(29.4%)with poor prognosis group(Engel Ⅱ-Ⅳ).Statistical analysis showed that SOP of TLE had statistical significance with the range of seizure-onset zone and etiology,but had no significant correlation with imaging findings,seizure site and prognosis.Multiple SOPs do not imply poor prognosis.The results of statistical analysis showed that the prognosis of patients and duration of epilepsy(course of disease),PET manifestations,whether the seizure-onset zone was completely removed,seizure site,and the etiology were statistically significant.The results of multivariate Logistic regression analysis showed that the seizure site and the complete removal of seizure-onset zone were independent predictors of surgical outcome.Conclusion:1.There are five different SOPs in temporal lobe epilepsy.2.The main determinants of the SOP are the etiology and the rang of the seizure-onset zone.This finding has important clinical significance to provide reference and basis for surgical decision-making.3.The seizure site located in the medial temporal lobe,the etiology type suggested focal cortical dysplasia,the PET findings suggested single focal hypometabolism,and the complete removal of the seizure-onset zone suggest good prognosis.The long duration of epilepsy suggests poor prognosis. |
PDF Full Text Request