Clinical features and surgical outcomes of posterior cingulate epilepsy

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-11-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.11.013

Zhaofen Yan, Mengyang Wang, Jing Wang, Jian Zhou, Y. Guan, G. Luan

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Abstract

Objective To investigate the clinical features and surgical outcomes of posterior cingulate epilepsy (PCE) confirmed by stereotacticelectroencephalogram (SEEG). Methods Eleven patients of PCE were retrospectively enrolled into this study who were identified by SEEG at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from June 2014 to August 2018. Among them, 9 underwent epileptogenic zonectomy involving post cingulate gyrus and 2 underwent SEEG-guided radiofrequency thermocoagulation of epileptogenic zone. Retrospective analysis was conducted on the patients′ clinical symptomological characteristics, electroencephalograms, and ictal SEEG. The Engel scale was used to evaluate the surgical outcomes. Results Among the 11 patients, preoperative scalp-EEG showed epileptiform discharges in the posterior temporal-parietal-occipital areas in 7 cases, anterior-middle temporal areas in 2, and no epileptiform discharge in 2 cases. Two patients showed simple partial motor seizures spreading to frontal and parietal areas on SEEG. Nine patients showed dialeptic and automotor seizures spreading to medial temporal areas on SEEG. The mean followed-up time after surgery was 13-48(29±12)months. Among the 9 patients undergoing resection of posterior cingulate gyrus, Engel Ⅰa was achieved in 7 cases, Ⅰc in 1 and Ⅱ in 1 case. Out of the 2 patients undergoing SEEG-guided radiofrequency thermocoagulation, 1 had 50% reduction of seizure frequency (Engel Ⅱ) and the other had 25% seizure reduction (Engel Ⅲ). For the 2 patients with posterior cingulate lesions, the seizure originated from the head of contralateral hippocampus and spread to ipsilateral hippocampus and posterior cingulate lesion. One out of the 2 patients was seizure free after resection of posterior cingulate gyrus. Conclusions The interictal discharges on scalp-EEG of PCE are often localized in posterior regional. The seizure semiology varies due to different spread networks among PCE patients verified by SEEG. SEEG could improve postoperative seizure-free rates in patients with PCE. The symptomatic and epileptogenic zones may be two different areas. Key words: Epilepsy; Disease attributes; Neurosurgical procedures; Prognosis; Posterior cingulated; Stereotacticelectroencephalogram

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后扣带癫痫的临床特点及手术疗效

目的探讨立体定向脑电图(SEEG)诊断后扣带癫痫(PCE)的临床特点及手术效果。方法回顾性分析2014年6月至2018年8月在首都医科大学三博脑科神经外科经SEEG诊断的11例PCE患者。其中9例行扣带后回致痫区切除术，2例行seeg引导下致痫区射频热凝。回顾性分析患者的临床症状特征、脑电图及心电图。采用恩格尔评分法评价手术效果。结果11例患者术前脑电图显示7例颞顶枕后区出现癫痫样放电，2例颞前中区出现癫痫样放电，2例无癫痫样放电。两名患者在SEEG上显示单纯性部分运动发作扩散到额叶和顶叶区域。9例患者在SEEG上显示渗渗性和运动性癫痫扩散到内侧颞区。术后平均随访时间13 ~ 48(29±12)个月。9例患者行扣带回后切除术，7例EngelⅠa, 1例Ⅰc, 1例Ⅱ。在2例接受seeg引导下射频热凝治疗的患者中，1例癫痫发作次数减少50% (EngelⅡ)，1例癫痫发作次数减少25% (EngelⅢ)。2例后扣带病变患者癫痫发作源自对侧海马头部，并向同侧海马及后扣带病变扩散。2例患者中1例在切除扣带回后无癫痫发作。结论PCE的头-脑电图间期放电多局限于后脑区。癫痫的符号学不同，由于不同的传播网络在PCE患者中被SEEG证实。SEEG可以提高PCE患者的术后无癫痫发生率，症状区和癫痫发生区可能是两个不同的区域。关键词:癫痫;疾病属性;外科手术;预后;后扣带回;Stereotacticelectroencephalogram

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.