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Vigabatrin-associated brain magnetic resonance imaging abnormalities and clinical symptoms in infants with tuberous sclerosis complex. 结节性硬化症患儿维加巴林相关脑磁共振成像异常及临床症状
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-06 DOI: 10.1111/epi.18190
Carmen Stevering, Maarten Lequin, Kinga Szczepaniak, Krzysztof Sadowski, Saba Ishrat, Alberto De Luca, Alexander Leemans, Willem Otte, David J Kwiatkowski, Paolo Curatolo, Bernhard Weschke, Kate Riney, Martha Feucht, Pavel Krsek, Rima Nabbout, Anna Jansen, Konrad Wojdan, Kamil Sijko, Jagoda Glowacka-Walas, Julita Borkowska, Dorota Domanska-Pakiela, Romina Moavero, Christoph Hertzberg, Hanna Hulshof, Theresa Scholl, Bořivoj Petrák, Miroslav Maminak, Eleonora Aronica, Jessie De Ridder, Lieven Lagae, Sergiusz Jozwiak, Katarzyna Kotulska, Kees Braun, Floor Jansen

Objective: Previous retrospective studies have reported vigabatrin-associated brain abnormalities on magnetic resonance imaging (VABAM), although clinical impact is unknown. We evaluated the association between vigabatrin and predefined brain magnetic resonance imaging (MRI) changes in a large homogenous tuberous sclerosis complex (TSC) cohort and assessed to what extent VABAM-related symptoms were reported in TSC infants.

Methods: The Dutch TSC Registry and the EPISTOP cohort provided retrospective and prospective data from 80 TSC patients treated with vigabatrin (VGB) before the age of 2 years and 23 TSC patients without VGB. Twenty-nine age-matched non-TSC epilepsy patients not receiving VGB were included as controls. VABAM, specified as T2/fluid-attenuated inversion recovery hyperintensity or diffusion restriction in predefined brain areas, were examined on brain MRI before, during, and after VGB, and once in the controls (at approximately age 2 years). Additionally, the presence of VABAM accompanying symptoms was evaluated.

Results: Prevalence of VABAM in VGB-treated TSC patients was 35.5%. VABAM-like abnormalities were observed in 13.5% of all patients without VGB. VGB was significantly associated with VABAM (risk ratio [RR] = 3.57, 95% confidence interval [CI] = 1.43-6.39), whereas TSC and refractory epilepsy were not. In all 13 VGB-treated patients with VABAM for whom posttreatment MRIs were available, VABAM entirely resolved after VGB discontinuation. The prevalence of symptoms was 11.7% in patients with VABAM or VABAM-like MRI abnormalities and 4.3% in those without, implicating no significant association (RR = 2.76, 95% CI = .68-8.77).

Significance: VABAM are common in VGB-treated TSC infants; however, VABAM-like abnormalities also occurred in children without either VGB or TSC. The cause of these MRI changes is unknown. Possible contributing factors are abnormal myelination, underlying etiology, recurrent seizures, and other antiseizure medication. Furthermore, the presence of VABAM (or VABAM-like abnormalities) did not appear to be associated with clinical symptoms. This study confirms that the well-known antiseizure effects of VGB outweigh the risk of VABAM and related symptoms.

目的:以前的回顾性研究已经报道了维加巴林相关的脑磁共振成像(VABAM)异常,尽管临床影响尚不清楚。在一个大型同质性结节性硬化症(TSC)队列中,我们评估了vigabatrin与预先确定的脑磁共振成像(MRI)变化之间的关系,并评估了TSC婴儿中vabam相关症状的报告程度。方法:荷兰TSC登记处和EPISTOP队列提供了80例2岁前接受维加巴林(VGB)治疗的TSC患者和23例未接受VGB治疗的TSC患者的回顾性和前瞻性数据。29例未接受VGB治疗的年龄匹配的非tsc癫痫患者作为对照。VABAM,指定为T2/流体衰减反转恢复高强度或预定义脑区域的扩散限制,在VGB之前,期间和之后进行脑MRI检查,并在对照组(大约2岁)进行一次检查。此外,还评估了伴有症状的VABAM的存在。结果:vgb治疗的TSC患者中VABAM的患病率为35.5%。在所有无VGB的患者中,13.5%观察到vabam样异常。VGB与VABAM有显著相关性(风险比[RR] = 3.57, 95%可信区间[CI] = 1.43-6.39),而TSC和难治性癫痫无显著相关性。在所有13例VGB治疗的VABAM患者中,治疗后mri可用,VABAM在VGB停药后完全消退。有VABAM或VABAM样MRI异常的患者出现症状的比例为11.7%,无VABAM样MRI异常的患者为4.3%,无显著相关性(RR = 2.76, 95% CI = 0.68 -8.77)。意义:VABAM在vgb治疗的TSC婴儿中很常见;然而,vabam样异常也发生在没有VGB或TSC的儿童中。这些MRI变化的原因尚不清楚。可能的影响因素有异常髓鞘形成、潜在病因、复发性癫痫发作和其他抗癫痫药物。此外,VABAM(或VABAM样异常)的存在似乎与临床症状无关。本研究证实,众所周知的VGB抗癫痫作用大于VABAM和相关症状的风险。
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引用次数: 0
Dynamics of magnetic cortico-cortical responses evoked by single-pulse electrical stimulation. 单脉冲电刺激诱发的皮质-皮质磁反应动力学。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-06 DOI: 10.1111/epi.18183
Odile Feys, Sophie Schuind, Claudine Sculier, Estelle Rikir, Benjamin Legros, Nicolas Gaspard, Vincent Wens, Xavier De Tiège

Objective: Intracranial single-pulse electrical stimulation (SPES) can elicit cortico-cortical evoked potentials. Their investigation with intracranial EEG is biased by the limited number and selected location of electrodes, which could be circumvented by simultaneous non-invasive whole-scalp recording. This study aimed at investigating the ability of magnetoencephalography (MEG) to characterize cortico-cortical evoked fields (CCEFs) and effective connectivity between the epileptogenic zone (EZ) and non-epileptogenic zone (i.e., non-involved [NIZ]).

Methods: A total of 301 SPES trains (at 0.9 Hz during 120 s) were performed in 10 patients with refractory focal epilepsy. MEG signals were denoised, epoched, averaged, and decomposed using independent component analysis. Significant response deflections and significant source generators were detected. Peak latency/amplitude were compared between each different cortical/subcortical structure of the NIZ containing more than five SPES, and then between the EZ and corresponding brain structures in the NIZ.

Results: MEG detected and localized polymorphic/polyphasic CCEFs, including one to eight significant consecutive deflections. The latency and amplitude of CCEFs within the NIZ differed significantly depending on the stimulated brain structure. Compared with the corresponding NIZ, SPES within the extratemporal EZ demonstrated delayed CCEF latency, whereas SPES within the temporal EZ showed decreased CCEF amplitude. SPES within the EZ elicited a significantly higher rate of CCEFs within the stimulated lobe compared with those within the NIZ.

Significance: This study reveals polymorphic CCEFs with complex spatiotemporal dynamics both within the NIZ and EZ. It highlights significant differences in effective connectivity of the epileptogenic network. These cortico-cortical evoked responses could thus contribute to increasing the yield of intracranial recordings.

目的:颅内单脉冲电刺激可诱发皮质-皮质诱发电位。他们对颅内脑电图的调查由于电极数量有限和选择的位置而有偏差,这可以通过同时进行无创全头皮记录来避免。本研究旨在探讨脑磁图(MEG)表征皮质-皮质诱发场(CCEFs)的能力,以及癫痫发生区(EZ)和非癫痫发生区(即非参与[NIZ])之间的有效连通性。方法:对10例难治性局灶性癫痫患者进行301次脉冲(0.9 Hz, 120 s)电刺激。采用独立分量分析对脑电信号进行去噪、epoch、平均和分解。检测到显著的响应偏转和显著的源发生器。比较含有5个以上SPES的脑区不同皮层/皮层下结构之间的峰值潜伏期/振幅,以及脑区与相应脑区结构之间的峰值潜伏期/振幅。结果:MEG检测并定位了多态/多相CCEFs,包括1至8个显著的连续偏转。脑区内CCEFs的潜伏期和振幅随受刺激脑结构的不同而有显著差异。与相应的NIZ相比,颞外EZ内的SPES表现出CCEF潜伏期的延迟,而颞内EZ内的SPES表现出CCEF振幅的降低。与NIZ内的SPES相比,EZ内的SPES在受刺激叶内引起的CCEFs发生率显著更高。意义:本研究揭示了在nz和EZ内具有复杂时空动态的多态CCEFs。它突出了致痫网络有效连接的显著差异。因此,这些皮质-皮质诱发反应可能有助于增加颅内记录的产量。
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引用次数: 0
The Imaging Database for Epilepsy And Surgery (IDEAS). 癫痫与外科影像数据库(IDEAS)。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18192
Peter N Taylor, Yujiang Wang, Callum Simpson, Vytene Janiukstyte, Jonathan Horsley, Karoline Leiberg, Beth Little, Harry Clifford, Sophie Adler, Sjoerd B Vos, Gavin P Winston, Andrew W McEvoy, Anna Miserocchi, Jane de Tisi, John S Duncan

Objective: Magnetic resonance imaging (MRI) is a crucial tool for identifying brain abnormalities in a wide range of neurological disorders. In focal epilepsy, MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence (AI) algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data.

Methods: Herein, we release an open-source data set of pre-processed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections and detailed demographic information. We also share scans from 100 healthy controls acquired on the same scanners. The MRI scan data include the preoperative three-dimensional (3D) T1 and, where available, 3D fluid-attenuated inversion recovery (FLAIR), as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age a onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical followup. Crucially, we also include resection masks delineated from post-surgical imaging.

Results: To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of ~50%. Our imaging data replicate findings of group-level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes.

Significance: We envisage that our data set, shared openly with the community, will catalyze the development and application of computational methods in clinical neurology.

目的:磁共振成像(MRI)是识别各种神经系统疾病中大脑异常的重要工具。在局灶性癫痫中,MRI用于识别大脑结构异常。对于隐蔽病变,机器学习和人工智能(AI)算法可以在视觉检查不明显的情况下改善病变检测。这种方法的成功取决于训练数据的数量和质量。方法:在此,我们发布了442例药物难治性局灶性癫痫患者的预处理MRI扫描数据集和详细的人口统计信息。我们还共享在同一扫描仪上获得的100个健康对照的扫描结果。MRI扫描数据包括术前三维(3D) T1,如果可能的话,3D流体衰减反演恢复(FLAIR),以及人工检查的完整表面重建和体积包裹。人口统计学信息包括年龄、性别、年龄、癫痫发作、手术部位、切除标本的组织病理学、局灶性癫痫发作的发生率和频率(伴有和不伴有意识障碍)、局灶性到双侧强直-阵挛性癫痫发作、手术时抗癫痫药物(ASMs)的数量,以及总共1764例患者术后随访年。至关重要的是,我们还包括术后成像描绘的切除面罩。结果:为了证明我们数据的准确性,我们成功地复制了先前的研究,显示癫痫发作自由的长期结果在~50%的范围内。与对照组相比,我们的影像学数据重复了患者组水平萎缩的发现。该队列的切除位置主要在颞叶和额叶。意义:我们设想我们的数据集,与社区公开共享,将催化临床神经病学计算方法的发展和应用。
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引用次数: 0
Epilepsy surgery education and practice around the globe: An ILAE taskforce report. 全球癫痫外科教育和实践:ILAE特别工作组报告。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18199
Johannes M Nico Enslin, Carrie R Muh, Xiongfei Wang, Tatiana von Hertwig Fernandes de Olivera, Guy M McKhann, Eyiyemisi Damisah, Faisal Al-Otaibi, Bertil Rydenhag, Rushna P Ali, Christian Dorfer, Dario J Englot, Arthur Cukiert

Up to 80% of the world's population with epilepsy lives in low and middle-income countries. Around one-third of these patients will have drug-resistant epilepsy, for which epilepsy surgery is an option. Unfortunately, many of these regions, as well as some more developed nations, lack sufficient epilepsy surgery units and trained neurosurgeons. With this in mind, the International League Against Epilepsy (ILAE) formed the Epilepsy Surgery Education Taskforce to address the shortage of further educational opportunities for surgeons and neurologists and to promote the creation of more epilepsy surgery units around the world. In this article, we publish our findings from a web-based international survey, in which we investigated the global distribution and experience of neurosurgeons who perform epilepsy surgery, their educational paths, and opinions on the further need for epilepsy surgery education, as well as the resources available to them. We report a detailed analysis of the 202 survey replies received from 35 different countries across six continents. The lack of adequate numbers of epilepsy surgery units in the Southern Hemisphere is notable, and the aim of this task force with other ILAE committees, is to improve access to epilepsy surgery for patients and to enhance training for their health care providers.

高达80%的世界癫痫患者生活在低收入和中等收入国家。这些患者中约有三分之一将患有耐药性癫痫,癫痫手术是一种选择。不幸的是,许多这些地区以及一些较发达的国家缺乏足够的癫痫手术单位和训练有素的神经外科医生。考虑到这一点,国际抗癫痫联盟(ILAE)成立了癫痫外科教育工作组,以解决外科医生和神经科医生进一步教育机会的短缺问题,并促进在世界各地建立更多的癫痫外科单位。在这篇文章中,我们发表了一项基于网络的国际调查的结果,在该调查中,我们调查了从事癫痫手术的神经外科医生的全球分布和经验,他们的教育途径,对进一步需要癫痫外科教育的意见,以及他们可用的资源。我们报告了对来自六大洲35个不同国家的202份调查回复的详细分析。值得注意的是,南半球缺乏足够数量的癫痫手术单位,该工作队与国际癫痫学会其他委员会的目的是改善患者接受癫痫手术的机会,并加强对其保健提供者的培训。
{"title":"Epilepsy surgery education and practice around the globe: An ILAE taskforce report.","authors":"Johannes M Nico Enslin, Carrie R Muh, Xiongfei Wang, Tatiana von Hertwig Fernandes de Olivera, Guy M McKhann, Eyiyemisi Damisah, Faisal Al-Otaibi, Bertil Rydenhag, Rushna P Ali, Christian Dorfer, Dario J Englot, Arthur Cukiert","doi":"10.1111/epi.18199","DOIUrl":"https://doi.org/10.1111/epi.18199","url":null,"abstract":"<p><p>Up to 80% of the world's population with epilepsy lives in low and middle-income countries. Around one-third of these patients will have drug-resistant epilepsy, for which epilepsy surgery is an option. Unfortunately, many of these regions, as well as some more developed nations, lack sufficient epilepsy surgery units and trained neurosurgeons. With this in mind, the International League Against Epilepsy (ILAE) formed the Epilepsy Surgery Education Taskforce to address the shortage of further educational opportunities for surgeons and neurologists and to promote the creation of more epilepsy surgery units around the world. In this article, we publish our findings from a web-based international survey, in which we investigated the global distribution and experience of neurosurgeons who perform epilepsy surgery, their educational paths, and opinions on the further need for epilepsy surgery education, as well as the resources available to them. We report a detailed analysis of the 202 survey replies received from 35 different countries across six continents. The lack of adequate numbers of epilepsy surgery units in the Southern Hemisphere is notable, and the aim of this task force with other ILAE committees, is to improve access to epilepsy surgery for patients and to enhance training for their health care providers.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Piriform cortex is an ictogenic trigger zone in the primate brain. 梨状皮质是灵长类动物大脑中的一个致ictogenic触发区。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18201
Karen Gale, David Dybdal, Evan Wicker, Carolina Campos-Rodriguez, Rafael S Maior, Catherine Elorette, Ludise Malkova, Patrick A Forcelli

Objective: Area tempestas, a functionally defined region in the anterior piriform cortex, was identified as a crucial ictogenic trigger zone in the rat brain in the 1980s. However, whether the primate piriform cortex can trigger seizures remains unknown. Here, in a nonhuman primate model, we aimed to localize a similar trigger zone in the piriform cortex and, subsequently, evaluated the ability of focal inhibition of the substantia nigra pars reticulata (SNpr) to suppress the evoked seizures.

Methods: Focal microinjection of the γ-aminobutyric acid type A (GABAA) antagonist bicuculline methiodide into the piriform cortex was performed, in macaque monkeys, on a within-subject basis to map the ictogenic regions within this area. Glutamate antagonists were used to characterize the local circuit pharmacology. Focal inhibition of the substantia nigra by infusion of the GABAA agonist muscimol suppressed seizures evoked from piriform cortex.

Results: We documented a well-defined region highly susceptible to bicuculline-induced seizures in the piriform cortex, just posterior to the junction of the frontal and temporal lobes, indicating that a functional homolog to the rodent area tempestas is present in the primate brain. Focal infusion of glutamate receptor antagonists into the area tempestas revealed that α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor-mediated, but not N-methyl-D-aspartate-mediated, neurotransmission was necessary for the expression of seizures. Pharmacological inhibition of the SNpr robustly suppressed area tempestas-evoked seizures.

Significance: Together, these data point to the area tempestas as a potent ictogenic zone in the primate brain and underscore the antiseizure effects of inhibition of the SNpr. Building on decades of studies in rodents, our present findings emphasize the relevance of these targets to the primate brain and provide further rationale for exploring these targets for clinical use.

目的:风暴区是20世纪80年代大鼠脑内梨状皮质前部的一个功能明确的区域,被认为是一个重要的致孕触发区。然而,灵长类动物的梨状皮质是否会引发癫痫仍然未知。在非人类灵长类动物模型中,我们旨在定位梨状皮质中类似的触发区,并随后评估黑质网状部(SNpr)的局灶抑制抑制诱发癫痫发作的能力。方法:将γ-氨基丁酸A型(GABAA)拮抗剂甲氧二库林在猕猴梨状皮质内局部显微注射,在受试者基础上绘制该区域内的致孕区。谷氨酸拮抗剂被用来表征局部回路药理学。输注GABAA激动剂muscimol对黑质的局灶性抑制抑制梨状皮质诱发的癫痫发作。结果:我们在额叶和颞叶交界处后方的梨状皮质中记录了一个明确定义的区域,该区域对双核碱诱发的癫痫非常敏感,这表明灵长类动物的大脑中存在与啮齿动物区域风暴的功能同源。谷氨酸受体拮抗剂局部输注到痉挛区显示α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体介导的神经传递是癫痫发作表达所必需的,而不是n -甲基- d -天冬氨酸介导的神经传递。SNpr的药理抑制有力地抑制了风暴诱发的区域癫痫发作。意义:综上所述,这些数据表明,在灵长类动物大脑中,风暴区是一个强有力的致痫区,并强调了抑制SNpr的抗癫痫作用。基于数十年来对啮齿动物的研究,我们目前的发现强调了这些靶点与灵长类动物大脑的相关性,并为探索这些靶点的临床应用提供了进一步的理论依据。
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引用次数: 0
Epilepsy surgery in children with operculoinsular epilepsy: Results of a large unicentric cohort. 包层岛型癫痫患儿的癫痫手术:一项大型单中心队列研究的结果。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18185
Martin Kudr, Radek Janca, Alena Jahodova, Anezka Belohlavkova, Matyas Ebel, Katerina Bukacova, Alice Maulisova, Michal Tichy, Petr Liby, Martin Kyncl, Zuzana Holubova, Jan Sanda, Petr Jezdik, Katerina Mackova, Gonzalo Alonso Ramos Rivera, Luka Kopac, Pavel Krsek

Objective: Epilepsy surgery in the operculoinsular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of postoperative deficits.

Methods: Pre- and postsurgical data from 30 pediatric patients who underwent operculoinsular cortex surgery at the Motol Epilepsy Center Prague from 2010 to 2022 were analyzed.

Results: Focal cortical dysplasia (FCD; n = 15, 50%) was the predominant cause of epilepsy, followed by epilepsy-associated tumors (n = 5, 17%) and tuberous sclerosis complex (n = 2, 7%). In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo-EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of >50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median = 6 years 5 months, range = 2 years to 13 years 5 months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema.

Significance: Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.

目的:由于癫痫区难以划定和术后缺陷的高风险,在岛盖皮层进行癫痫手术具有挑战性。方法:对2010年至2022年在布拉格Motol癫痫中心接受岛包皮层手术的30例儿童患者的术前和术后数据进行分析。结果:局灶性皮质发育不良(FCD);N = 15, 50%)是癫痫的主要病因,其次是癫痫相关肿瘤(N = 5, 17%)和结节性硬化症(N = 2.7, 7%)。在最有可能病因为FCD的8例患者中,组织学为阴性。7例(23%)磁共振成像结果正常。癫痫发作表现出不同的符号学和传播模式(额叶、前脑和颞叶)。头期和间歇期脑电图(EEG)的发现大多是广泛的。多模态成像和先进的后处理是常用的方法。应用立体脑电图对23例(77%)患者的致痫区和雄辩皮层进行定位。斜向电极用于指导更好的神经外科医生定位。16例癫痫发生区位于优势半球。在2年的随访中,22名患者(73%)完全无癫痫发作,8名患者(27%)癫痫发作频率降低了50%(国际抗癫痫联盟3级和4级)。14名患者(47%)接受了抗癫痫药物减量治疗;2例(7%)完全停药。19名患者(63%)在最终结果评估后仍无癫痫发作(中位=术后6年5个月,范围=术后2年至13年5个月)。6例(20%)出现放射状冠或基底神经节缺血;4例(13%)改善为轻度偏瘫,1例(3%)改善为中度偏瘫。2例(7%)在脑岛前部手术并切除额颞叶的患者出现了主要并发症:脑桥缺血和术后脑水肿。意义:在岛包皮层进行癫痫手术可获得良好的患者预后。全面的诊断方法是手术成功的关键。康复治疗为术后缺陷的显著恢复带来了很大的机会。
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引用次数: 0
Peak width of skeletonized mean diffusivity as a marker of small vessel disease in patients with temporal lobe epilepsy with hippocampal sclerosis. 颞叶癫痫伴海马硬化患者骨化平均弥漫性峰宽与小血管病变的关系
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18205
Dong Ah Lee, Ho-Joon Lee, Sung Eun Kim, Kang Min Park

Objective: White matter abnormalities in patients with temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) are well known. Peak width of skeletonized mean diffusivity (PSMD) is a novel marker for quantifying white matter integrity that may reflect small vessel disease. In this study, we aimed to quantify the extent of white matter damage in patients with TLE and HS by using PSMD.

Methods: We enrolled 52 patients with TLE with HS and 54 age- and sex-matched healthy controls. Diffusion tensor imaging (DTI) was performed using a 3-T magnetic resonance imaging scanner. We measured PSMD using DTI findings and compared PSMD between patients with TLE with HS and healthy controls. We also evaluated the correlation between PSMD and clinical factors in patients with TLE and HS.

Results: PSMD differed significantly between healthy controls and patients with TLE and HS, and it was higher in the patients (2.375 × 10-4 mm2/s vs. 2.108 × 10-4 mm2/s, p < .001). Furthermore, PSMD in the ipsilateral hemisphere of the HS was higher than in the contralateral hemisphere of the HS (2.472 × 10-4 mm2/s vs. 2.258 × 10-4 mm2/s, p = .040). PSMD was positively correlated with age (r = .512, p < .001) and age at seizure onset (r = .423, p = .002) in patients with TLE and HS.

Significance: Patients with TLE and HS had higher PSMD values than healthy controls, and PSMD was positively correlated with age. These findings provide evidence of white matter damage probably due to small vessel disease in patients with TLE and HS and support the feasibility of PSMD as a promising imaging marker for epileptic disorders.

目的:颞叶癫痫(TLE)和海马硬化(HS)患者的白质异常是众所周知的。骨化平均扩散率峰宽(PSMD)是一种量化白质完整性的新指标,可以反映小血管疾病。在本研究中,我们旨在通过PSMD来量化TLE和HS患者的白质损伤程度。方法:我们招募了52例合并HS的TLE患者和54例年龄和性别匹配的健康对照。采用3-T磁共振成像扫描仪进行弥散张量成像(DTI)。我们使用DTI结果测量PSMD,并比较TLE合并HS患者和健康对照之间的PSMD。我们还评估了TLE和HS患者PSMD与临床因素的相关性。结果:正常对照组与TLE、HS患者PSMD差异有统计学意义,其中患者PSMD更高(2.375 × 10-4 mm2/s vs. 2.108 × 10-4 mm2/s, p -4 mm2/s vs. 2.258 × 10-4 mm2/s, p = 0.040)。PSMD与年龄呈正相关(r =。512, p意义:TLE和HS患者PSMD值高于健康对照组,且PSMD与年龄正相关。这些发现为TLE和HS患者的白质损伤可能由小血管疾病引起提供了证据,并支持PSMD作为一种有希望的癫痫疾病成像标志物的可行性。
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引用次数: 0
Exploring the impact of climate change on epilepsy: Insights from the 15th European Epilepsy Congress. 探讨气候变化对癫痫的影响:来自第15届欧洲癫痫大会的见解。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18208
James Mills, Alessia Romagnolo, Giulia Battaglia, Sara Eyal, Medine I Gulcebi, Bernadette Macrohon, Sanjay M Sisodiya, Annamaria Vezzani
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引用次数: 0
Did Joseph Conrad have juvenile myoclonic epilepsy? 约瑟夫·康拉德患有幼年型肌阵挛性癫痫吗?
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1111/epi.18206
Peter Wolf, Dieter Hein

Joseph Conrad's epilepsy is well documented but has received little attention as he had convulsive seizures only in childhood and adolescence. The type of epilepsy has never been discussed. His biography reveals that his condition was decidedly neuropsychiatric with depression, a suicidal attempt, and prominent signs of frontal lobe dysfunction, as is seen typically in juvenile myoclonic epilepsy. This diagnosis is supported by a congruent family history and probable lifelong myoclonic seizures including reflex myocloni that were misunderstood as nervosity. It is impressive to see how he disciplined himself to become a great writer against the odds of neuropsychological impairment.

约瑟夫·康拉德的癫痫有充分的文献记载,但很少受到关注,因为他只在童年和青春期抽搐发作。癫痫的类型从未被讨论过。他的传记显示,他的病情显然是神经精神疾病,伴有抑郁症、自杀企图和明显的额叶功能障碍,这是青少年肌阵挛性癫痫的典型症状。这一诊断是由一致的家族史和可能终生的肌阵挛性发作支持,包括反射性肌阵挛,被误解为神经紧张。看到他如何克服神经心理障碍,刻苦训练,成为一名伟大的作家,令人印象深刻。
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引用次数: 0
EEC 2024 Author Index EEC 2024作者索引
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-29 DOI: 10.1111/epi.18152
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引用次数: 0
期刊
Epilepsia
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