不同皮质结节放射学亚型的致痫性谱:立体脑电图研究。

IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY
Epilepsia Pub Date : 2025-09-16 DOI:10.1111/epi.18639
Haixiang Wang, Aileen McGonigal, Bingqing Zhang, Qian Feng, Jie Shi, Jing He, Jianjun Bai, Jiuluan Lin, Siyu Wang, Xiaoyan Liu, Liping Zou, Wenjing Zhou
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引用次数: 0

摘要

目的:结节性硬化症(TSC)引起局灶性耐药癫痫。预测哪些块茎是致癫痫的仍然具有挑战性。我们利用立体脑电图(SEEG)研究了tsc相关癫痫的致痫区(EZ)组织,重点研究了不同结节放射学亚型的致痫性。方法:回顾性研究SEEG扫描的连续tsc相关性癫痫患者。确定存在“灶性EZ”(包括“灶性结节”、“结节+”和“灶性非结节”)或“弥漫性EZ”。在涉及块茎的局灶性EZ中,将发作期和发作期致癫痫生物标志物与块茎的放射学外观进行比较。除了先前描述的四种块茎亚型外,我们提出了一种新的亚型:E型(局灶性皮质凹陷,基于T2/液体衰减反转恢复的低信号)。结果:63例患者中,55例(87.3%)出现局灶性EZ,包括局灶性结节(n = 32, 50.8%)、结节+ (n = 11, 17.5%)和局灶性非结节(n = 12, 19.0%,其中7/12涉及局灶性皮质发育不良[FCD])。63例灶性EZ患者中43例(68.3%)至少累及一个结节,对265个结节的致痫性进行放射学亚型分析。块茎亚型A和B最常见(186/265,70.2%),但在SEEG上的致痫性最小。与A/B/C型相比,致痫性最高的是D亚型(77.8%)和E亚型(77.5%)(Fisher精确检验;p均有意义:大多数tsc相关癫痫表现为与结节相关的局灶性EZ,但局灶性外EZ也可能发生(FCD或海马)。影像学上,钙化块茎(D型)和局灶性皮质凹陷和中枢性低密度块茎(E型)表现出最高的致痫性,与FCD II型相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Spectrum of epileptogenicity in different cortical tuber radiological subtypes: A stereoelectroencephalographic study.

Objective: Tuberous sclerosis complex (TSC) causes focal drug-resistant epilepsy. Prediction of which tubers are epileptogenic remains challenging. We used stereoelectroencephalography (SEEG) to investigate epileptogenic zone (EZ) organization in TSC-related epilepsy, focusing on epileptogenicity of different tuber radiological subtypes.

Methods: We retrospectively studied consecutive patients with TSC-related epilepsy explored by SEEG. Presence of "focal EZ" (comprising "focal tuber," "tuber-plus," and "focal nontuber") or "diffuse EZ" was determined. In focal EZ involving tubers, interictal and ictal epileptogenic biomarkers were compared to the radiological appearance of tubers. In addition to four previously described tuber subtypes, we propose a novel subtype: type E (focal cortical depression, hypointense base on T2/fluid-attenuated inversion recovery).

Results: Among 63 patients, 55 (87.3%) patients exhibited focal EZ, including focal tuber (n = 32, 50.8%), tuber-plus (n = 11, 17.5%), and focal nontuber (n = 12, 19.0%, of which 7/12 involved focal cortical dysplasia [FCD]). In the 43 of 63 (68.3%) patients with focal EZ involving at least one tuber, epileptogenicity of 265 explored tubers was analyzed with regard to radiological subtypes. Tuber subtypes A and B were most prevalent (186/265, 70.2%) but among the least epileptogenic on SEEG. The highest ictal epileptogenicity was in subtypes D (77.8%) and E (77.5%) compared to type A/B/C (Fisher exact test; all p < .05). Type D/E tubers exhibited higher interictal biomarkers than type A/B/ C (linear mixed model; p < .05). In patients with focal EZ, following surgical intervention, 36 of 55 (65.5%) achieved Engel class I outcomes, with a higher odds ratio of Engel I in the combined group of focal tuber/focal nontuber compared to tuber-plus EZ (p < .05).

Significance: Most TSC-related epilepsy represents focal EZ related to tubers, but focal extratuber EZ can also occur (FCD or hippocampus). Radiologically, calcified tubers (type D) and tubers with focal cortical depression and central hypointensity (type E) exhibit the highest epileptogenicity, similar to FCD type II.

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来源期刊
Epilepsia
Epilepsia 医学-临床神经学
CiteScore
10.90
自引率
10.70%
发文量
319
审稿时长
2-4 weeks
期刊介绍: Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.
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