Significance Of Video-EEG In The Diagnosis Of The Location In Intractable Non-convulsive Seizure Epilepsy And Presurgical Evaluation On The Epileptogenic Lesion

Objective:To explore the significance of long time Video-EEG in the diagnosis of refractory non-convulsive seizure and preoperative localization of epileptogenic zone.Methods:49 patients of refractory epilepsy who with the non-convulsive seizures were checked by VEEG. Analysis the interictal and ictal discharge and combine with the ictal clinical symptoms seen in the video, to lateralization and localization of epileptogenic zone. All patients were checked by MRI,18 patients had definite lesions; 30 patients were checked by interictal PCT-CT; 14 patients were checked by MEG. All patients did the preoperative evaluation on epileptogenic zone, then 21 patients with surgical treatment, the accuracy of epileptogenic zone was validated with intraoperative electrocorticography(ECoG).The results were observed for 6～19 months after surgery. Observation including reservations of neurological function, the improvement in seizures. Evaluation the effects after surgery according to Engel criteria. Verify the accuracy of epileptogenic zone localization.Results:49 patients were monitored by VEEG for 24～72h.182 non-convulsive seizures were observed in which unknown seizure type in past medical history was found in the 8 patients. Non-convulsive seizure symptoms include:automatic seizures, visceral sensation seizures, vegetative nervous seizures, somatosensory seizures, mental seizures, absence seizures and gelastic seizures.In all patients clinically seizures and ictal discharge (2～20 times) were watched.45(95.9%) patients records the interictal discharge monitoring by VEEG.43 (87.8%) patients can be clearly location the side of epileptogenic zone by analysis the distribution results of interictal EEG and ictal EEG, but 3 patients locationed the opposite sides of epileptogenic zone,standard by ictal EEG. The statistical analysis showed that ictaland interictal lateralization have a high consistency (Kappa=0.557, P<0.05). The seizure onset zone was consistent with symptomatogenic zone in 37 (75.5%) patients (Kappa=0.782, P<0.001).Comprehensive analysis non-convulsive seizure symptoms and ictal EEG show that frontal lobe epilepsy prone to sleep, a few in the wake of the emergence, ictal EEG more likely to spread to all lead (P<0.05). Temporal lobe epilepsy prone to awake, ictal EEG more likely to spread to frontal lobe.The coincidence rates of VEEG methods on localizing epileptogenic zone with the abnormal MRI were 100% respectively,with PET-CT was 82.35%,and with MEG was 92.9%.VEEG was consistent with ECoG in the 16 patients who with surgical treatment, but in other 5 patients the abnormal ECoG more extensive than VEEG. Efficacy evaluation after the standard by Engle:I 10 cases;Ⅱ7 cases;Ⅲ4 cases;Ⅳlevel 0 cases.Conclusion:VEEG can improve the detection rate of non-convulsive seizure and also has a notable value in diagnosis classification.Meanwhile, it has higher consistency with a variety of neural structures and functional imaging in the preoperative localization imaging epileptogenic focus areas, so VEEG has significance in preoperative localization of epilepsy surgery. It is an essential examination on presurgical evaluation in intractable epilepsy.