Intracranial electroencephalography（i EEG）provides the best precision in estimating the location and boundary of an epileptogenic zone. Analysis of i EEG in the routine EEG frequency range（0.5-70 Hz） remains the b...Intracranial electroencephalography（i EEG）provides the best precision in estimating the location and boundary of an epileptogenic zone. Analysis of i EEG in the routine EEG frequency range（0.5-70 Hz） remains the basis in clinical practice. Low-voltage fast activity is the most commonly reported ictal onset pattern in neocortical epilepsy, and low-frequency high-amplitude repetitive spiking is the most commonly reported ictal onset pattern in mesial temporal lobe epilepsy. Recent studies using wideband EEG recording have demonstrated that examining higher（80-1000 Hz） and lower（0.016-0.5 Hz） EEG frequencies can provide additional diagnostic information and help to improve the surgical outcome. In addition,novel computational techniques of i EEG signal analysis have provided new insights into the epileptic network.Here, we review some of these recent advances. Although these sophisticated and advanced techniques of i EEG analysis show promise in localizing the epileptogenic zone,their utility needs to be further validated in larger studies.展开更多
This paper presented 51 cases of intractable epilepsy, of which 36 were males, and 15 females,with a mean age of 21. They were all verified through CT/MRI, among which 17 were proved to have lesions on the brain, and ...This paper presented 51 cases of intractable epilepsy, of which 36 were males, and 15 females,with a mean age of 21. They were all verified through CT/MRI, among which 17 were proved to have lesions on the brain, and 34 to bave no lesion. Before operation all the patients were identified by SPECT and cerebral blood flow imaging (CBF). During the operation they were monitored under subdural strip electrode ECoG for the localization of corticoepileptogenic focus. The results showed that the sensitivity rate of localization with SPECT for corticoepileptogenic focus location was 97.87 %.展开更多
Background:Epilepsy is a neurological disorder characterized by recurrent seizures due to hyperexcitable neuronal network activity.The manifestations vary widely,ranging from subtle sensory disturbances to profound al...Background:Epilepsy is a neurological disorder characterized by recurrent seizures due to hyperexcitable neuronal network activity.The manifestations vary widely,ranging from subtle sensory disturbances to profound alterations of consciousness,depending on which brain regions are affected and their underlying etiology.Exploring the biophysical mechanisms of epileptic seizures holds significant for predicting and controlling the disease.Methods:We analyzed 45 spontaneous seizures recorded from 24 patients with focal epilepsy,as well as stimulation-induced seizures from 2 additional patients.A second-order Butterworth low-pass filter isolated the slow-varying direct current(Sv DC)component(0.01-0.5 Hz),a frequency range often overlooked in electroencephalography(EEG).The energy ratio of the Sv DC component was calculated by dividing its total energy by the total signal energy during seizures and over a 1-hour period including the seizure,enabling comparison between ictal and interictal states.Results:The Sv DC component exhibited spatially dynamic changes during both ictal and interictal periods and showed a moderate correlation with high-frequency activity.Moreover,it accounted for a high energy proportion in both periods,with seizure data showing that 80.82%of leads had≥60%Sv DC energy.Notably,interictal Sv DC fluctuations were more pronounced in electrodes located within the epileptogenic zone,suggesting its potential as a marker for epileptogenic localization.Furthermore,the temporal variability of the Sv DC signal,reflected in its dispersion,demonstrates potential as an early indicator of seizure development.Conclusions:The Sv DC component may reflect local voltage differences likely linked to ion channel activity,potentially contributing to seizure initiation.Combined analysis of Sv DC with low-and high-frequency components offers a comprehensive framework for understanding epileptic networks and guiding diagnosis and therapy.展开更多
There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and res...There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and resect the epileptogenic lesions responsible for focal epilepsy.This study aims to show the benefit of dedicated epilepsy MRI sequences in the diagnosis of focal epilepsies.A general electric 1.5 Tesla MRI machine was used with standard and special sequences.Also,a Nihon Kohden electroencephalography(EEG)machine was used.This is a prospective observational study that included 51 patients with focal epilepsies who had an initial negative brain imaging.They underwent epilepsy MRI sequences along with a prolonged video EEG monitoring to localize the lesion,and then results were analyzed statistically using SPSS 22 program.The majority of patients were males(62.75%)with a mean age of 30 years.The grand majority of patients(74.5%,p value of 0.001)had their lesion localized by the epilepsy MRI.The most commonly found pathology was mesial temporal sclerosis.A significant number of patients(23.5%)were sent for an epilepsy surgery(p value 0.002).This study shows the significant impact of dedicated epilepsy MRI sequences on the diagnosis and management of focal epilepsy in the Lebanese population.展开更多
Temporal lobe epilepsy(TLE)is the most common form of focal epilepsy in adults,with approximately 30%of patients developing drug resistance and requiring surgical evaluation[1].Epilepsy surgery achieves seizure-freedo...Temporal lobe epilepsy(TLE)is the most common form of focal epilepsy in adults,with approximately 30%of patients developing drug resistance and requiring surgical evaluation[1].Epilepsy surgery achieves seizure-freedom in a substantial proportion of cases[2].However,complex presentations of TLE remain difficult to manage surgically due to incongruent or indeterminate presurgical findings,which complicate delineation of the epileptogenic zone(EZ)and increase the likelihood of treatment failure.展开更多
Background:The combination of high-frequency oscillations(HFOs)with single-mode imaging methods has been proved useful in identifying epileptogenic zones,whereas few studies have examined HFOs combined with multimodal...Background:The combination of high-frequency oscillations(HFOs)with single-mode imaging methods has been proved useful in identifying epileptogenic zones,whereas few studies have examined HFOs combined with multimodal imaging methods.The aim of this study was to evaluate the prognostic value of ripples,an HFO subtype with a frequency of 80 to 200 Hz is combined with multimodal imaging methods in predicting epilepsy surgery outcome.Methods:HFOs were analyzed in 21 consecutive medically refractory epilepsy patients who underwent epilepsy surgery.All patients underwent positron emission tomography(PET)and deep electrode implantation for stereo-electroencephalography(SEEG);11 patients underwent magnetoencephalography(MEG).Sensitivity,specificity,positive predictive value,negative predictive value,and accuracy in predicting surgical outcome were calculated for ripples combined with PET,MEG,both PET and MEG,and PET combined with MEG.Kaplan-Meier survival analyses were conducted in each group to estimate prognostic value.Results:The study included 13 men and 8 women.Accuracy for ripples,PET,and MEG alone in predicting surgical outcome was 42.9%,42.9%,and 81.8%,respectively.Accuracy for ripples combined with PET and MEG was the highest.Resection of regions identified by ripples,MEG dipoles,and combined PET findings was significantly associated with better surgical outcome(P<0.05).Conclusions:Intracranial electrodes are essential to detect regions which generate ripples and to remove these areas which indicate good surgical outcome for medically intractable epilepsy.With the assistance of presurgical noninvasive imaging examinations,PET and MEG,for example,the SEEG electrodes would identify epileptogenic regions more effectively.展开更多
Invasive techniques are becoming increasingly important in the presurgical evaluation of epilepsy.Adopting the electrophysiological source imaging(ESI)of interictal scalp electroencephalography(EEG)to localize the epi...Invasive techniques are becoming increasingly important in the presurgical evaluation of epilepsy.Adopting the electrophysiological source imaging(ESI)of interictal scalp electroencephalography(EEG)to localize the epileptogenic zone remains a challenge.The accuracy of the preoperative localization of the epileptogenic zone is key to curing epilepsy.The T1 MRI and the boundary element method were used to build the realistic head model.To solve the inverse problem,the distributed inverse solution and equivalent current dipole(ECD)methods were employed to locate the epileptogenic zone.Furthermore,a combination of inverse solution algorithms and Granger causality connectivity measures was evaluated.The ECD method exhibited excellent focalization in lateralization and localization,achieving a coincidence rate of 99.02%(p<0.05)with the stereo electroencephalogram.The combination of ECD and the directed transfer function led to excellent matching between the information flow obtained from intracranial and scalp EEG recordings.The ECD inverse solution method showed the highest performance and could extract the discharge information at the cortex level from noninvasive low-density EEG data.Thus,the accurate preoperative localization of the epileptogenic zone could reduce the number of intracranial electrode implantations required.展开更多
Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine ...Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.展开更多
Background Hypothalamic hamartoma(HH)is a congenital non-progressive lesion of hypothalamus during fetal development.Mass-like lesions in different anatomical locations often develop a variously disabling course prese...Background Hypothalamic hamartoma(HH)is a congenital non-progressive lesion of hypothalamus during fetal development.Mass-like lesions in different anatomical locations often develop a variously disabling course presenting with cognitive decline,psychiatric symptoms,as well as multiple seizure types.As a rare disease,HH is relatively common in infants and children,but it is extremely rare in adults.Case presentation We reported a case of adult-onset hypothalamic hamartoma,and summarized and analyzed relevant reports and studies of HH worldwide.The patient had clinical manifestations characterized by multiple seizure forms.After stereotactic radiofrequency thermocoagulation and drug treatment,the condition was effectively controlled.The patient was followed up till October 2022,with no recurrence of seizures.Conclusions Epilepsy caused by HH can resemble that of temporal lobe seizures,as HH forms a complex epileptogenic network with other regions of the brain through anatomical and functional connections.Early treatment of HH can provide better control of the symptoms of epilepsy,and patients with longer disease courses may have more complications.展开更多
Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perile...Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perilesional area contributes to the epileptogenicity.Case presentation In the case presented in this report,the patient,a 24-year-old Caucasian male,developed a refractory status epilepticus after a surgical attempt to remove a cerebral ganglioglioma.The postoperative magnetic resonance imaging revealed that the lesion was intact,and that inadvertently only the perilesional area and adjacent cortex had been resected.The patient underwent a new surgical procedure where the ganglioglioma was removed,and the status epilepticus cessated.Conclusions This clinical case suggests that the lesion itself plays an important role in seizure generation and propagation,and notably,that the surrounding cortex by an inhibitory action can act as a gate to seizure spread.展开更多
基金supported by the National Natural Science Foundation of China (81271435 and 91332202)
文摘Intracranial electroencephalography（i EEG）provides the best precision in estimating the location and boundary of an epileptogenic zone. Analysis of i EEG in the routine EEG frequency range（0.5-70 Hz） remains the basis in clinical practice. Low-voltage fast activity is the most commonly reported ictal onset pattern in neocortical epilepsy, and low-frequency high-amplitude repetitive spiking is the most commonly reported ictal onset pattern in mesial temporal lobe epilepsy. Recent studies using wideband EEG recording have demonstrated that examining higher（80-1000 Hz） and lower（0.016-0.5 Hz） EEG frequencies can provide additional diagnostic information and help to improve the surgical outcome. In addition,novel computational techniques of i EEG signal analysis have provided new insights into the epileptic network.Here, we review some of these recent advances. Although these sophisticated and advanced techniques of i EEG analysis show promise in localizing the epileptogenic zone,their utility needs to be further validated in larger studies.
文摘This paper presented 51 cases of intractable epilepsy, of which 36 were males, and 15 females,with a mean age of 21. They were all verified through CT/MRI, among which 17 were proved to have lesions on the brain, and 34 to bave no lesion. Before operation all the patients were identified by SPECT and cerebral blood flow imaging (CBF). During the operation they were monitored under subdural strip electrode ECoG for the localization of corticoepileptogenic focus. The results showed that the sensitivity rate of localization with SPECT for corticoepileptogenic focus location was 97.87 %.
基金supported by the National Natural Science Foundation of China(82271494)the STI2030-Major Project(2021ZD0201605)the National Natural Science Foundation of China Major Project(62293552).
文摘Background:Epilepsy is a neurological disorder characterized by recurrent seizures due to hyperexcitable neuronal network activity.The manifestations vary widely,ranging from subtle sensory disturbances to profound alterations of consciousness,depending on which brain regions are affected and their underlying etiology.Exploring the biophysical mechanisms of epileptic seizures holds significant for predicting and controlling the disease.Methods:We analyzed 45 spontaneous seizures recorded from 24 patients with focal epilepsy,as well as stimulation-induced seizures from 2 additional patients.A second-order Butterworth low-pass filter isolated the slow-varying direct current(Sv DC)component(0.01-0.5 Hz),a frequency range often overlooked in electroencephalography(EEG).The energy ratio of the Sv DC component was calculated by dividing its total energy by the total signal energy during seizures and over a 1-hour period including the seizure,enabling comparison between ictal and interictal states.Results:The Sv DC component exhibited spatially dynamic changes during both ictal and interictal periods and showed a moderate correlation with high-frequency activity.Moreover,it accounted for a high energy proportion in both periods,with seizure data showing that 80.82%of leads had≥60%Sv DC energy.Notably,interictal Sv DC fluctuations were more pronounced in electrodes located within the epileptogenic zone,suggesting its potential as a marker for epileptogenic localization.Furthermore,the temporal variability of the Sv DC signal,reflected in its dispersion,demonstrates potential as an early indicator of seizure development.Conclusions:The Sv DC component may reflect local voltage differences likely linked to ion channel activity,potentially contributing to seizure initiation.Combined analysis of Sv DC with low-and high-frequency components offers a comprehensive framework for understanding epileptic networks and guiding diagnosis and therapy.
文摘There have been many advances in the diagnosis and management of focal epilepsies particularly with neuroimaging techniques and magnetic resonance imaging(MRI).Special MRI sequences can be employed to localize and resect the epileptogenic lesions responsible for focal epilepsy.This study aims to show the benefit of dedicated epilepsy MRI sequences in the diagnosis of focal epilepsies.A general electric 1.5 Tesla MRI machine was used with standard and special sequences.Also,a Nihon Kohden electroencephalography(EEG)machine was used.This is a prospective observational study that included 51 patients with focal epilepsies who had an initial negative brain imaging.They underwent epilepsy MRI sequences along with a prolonged video EEG monitoring to localize the lesion,and then results were analyzed statistically using SPSS 22 program.The majority of patients were males(62.75%)with a mean age of 30 years.The grand majority of patients(74.5%,p value of 0.001)had their lesion localized by the epilepsy MRI.The most commonly found pathology was mesial temporal sclerosis.A significant number of patients(23.5%)were sent for an epilepsy surgery(p value 0.002).This study shows the significant impact of dedicated epilepsy MRI sequences on the diagnosis and management of focal epilepsy in the Lebanese population.
基金supported by the Beijing Municipal Science&Technology Commission(Z231100004823035)the Capital Medical University Cultivation Project(PYZ24128)CAAE Epilepsy Research Fund(CU-2024-010).
文摘Temporal lobe epilepsy(TLE)is the most common form of focal epilepsy in adults,with approximately 30%of patients developing drug resistance and requiring surgical evaluation[1].Epilepsy surgery achieves seizure-freedom in a substantial proportion of cases[2].However,complex presentations of TLE remain difficult to manage surgically due to incongruent or indeterminate presurgical findings,which complicate delineation of the epileptogenic zone(EZ)and increase the likelihood of treatment failure.
文摘Background:The combination of high-frequency oscillations(HFOs)with single-mode imaging methods has been proved useful in identifying epileptogenic zones,whereas few studies have examined HFOs combined with multimodal imaging methods.The aim of this study was to evaluate the prognostic value of ripples,an HFO subtype with a frequency of 80 to 200 Hz is combined with multimodal imaging methods in predicting epilepsy surgery outcome.Methods:HFOs were analyzed in 21 consecutive medically refractory epilepsy patients who underwent epilepsy surgery.All patients underwent positron emission tomography(PET)and deep electrode implantation for stereo-electroencephalography(SEEG);11 patients underwent magnetoencephalography(MEG).Sensitivity,specificity,positive predictive value,negative predictive value,and accuracy in predicting surgical outcome were calculated for ripples combined with PET,MEG,both PET and MEG,and PET combined with MEG.Kaplan-Meier survival analyses were conducted in each group to estimate prognostic value.Results:The study included 13 men and 8 women.Accuracy for ripples,PET,and MEG alone in predicting surgical outcome was 42.9%,42.9%,and 81.8%,respectively.Accuracy for ripples combined with PET and MEG was the highest.Resection of regions identified by ripples,MEG dipoles,and combined PET findings was significantly associated with better surgical outcome(P<0.05).Conclusions:Intracranial electrodes are essential to detect regions which generate ripples and to remove these areas which indicate good surgical outcome for medically intractable epilepsy.With the assistance of presurgical noninvasive imaging examinations,PET and MEG,for example,the SEEG electrodes would identify epileptogenic regions more effectively.
基金Supported by the National Key R&D Program of China(2022YFC2402203)the Key R&D Program of Hebei(21372002D)。
文摘Invasive techniques are becoming increasingly important in the presurgical evaluation of epilepsy.Adopting the electrophysiological source imaging(ESI)of interictal scalp electroencephalography(EEG)to localize the epileptogenic zone remains a challenge.The accuracy of the preoperative localization of the epileptogenic zone is key to curing epilepsy.The T1 MRI and the boundary element method were used to build the realistic head model.To solve the inverse problem,the distributed inverse solution and equivalent current dipole(ECD)methods were employed to locate the epileptogenic zone.Furthermore,a combination of inverse solution algorithms and Granger causality connectivity measures was evaluated.The ECD method exhibited excellent focalization in lateralization and localization,achieving a coincidence rate of 99.02%(p<0.05)with the stereo electroencephalogram.The combination of ECD and the directed transfer function led to excellent matching between the information flow obtained from intracranial and scalp EEG recordings.The ECD inverse solution method showed the highest performance and could extract the discharge information at the cortex level from noninvasive low-density EEG data.Thus,the accurate preoperative localization of the epileptogenic zone could reduce the number of intracranial electrode implantations required.
基金This work was supported by the National Key R&D Program of China(No.2022YFC2503800)the National Natural Science Foundation of China(No.82071454)Beijing Municipal Science&Technology Commission(No.Z211100002921032).
文摘Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.
基金supported by the foundation of Medical Science and Technology of Guangdong(A2022402).
文摘Background Hypothalamic hamartoma(HH)is a congenital non-progressive lesion of hypothalamus during fetal development.Mass-like lesions in different anatomical locations often develop a variously disabling course presenting with cognitive decline,psychiatric symptoms,as well as multiple seizure types.As a rare disease,HH is relatively common in infants and children,but it is extremely rare in adults.Case presentation We reported a case of adult-onset hypothalamic hamartoma,and summarized and analyzed relevant reports and studies of HH worldwide.The patient had clinical manifestations characterized by multiple seizure forms.After stereotactic radiofrequency thermocoagulation and drug treatment,the condition was effectively controlled.The patient was followed up till October 2022,with no recurrence of seizures.Conclusions Epilepsy caused by HH can resemble that of temporal lobe seizures,as HH forms a complex epileptogenic network with other regions of the brain through anatomical and functional connections.Early treatment of HH can provide better control of the symptoms of epilepsy,and patients with longer disease courses may have more complications.
基金Region Skane and from the Swedish state under the agreement between the Swedish government and the county councils,the ALF agreement(PI J Bengzon).
文摘Background Gangliogliomas are brain tumors associated with drug-resistant focal epilepsy.In most cases,seizures improve after surgical treatment.It is still not concluded to what extent the lesion itself or the perilesional area contributes to the epileptogenicity.Case presentation In the case presented in this report,the patient,a 24-year-old Caucasian male,developed a refractory status epilepticus after a surgical attempt to remove a cerebral ganglioglioma.The postoperative magnetic resonance imaging revealed that the lesion was intact,and that inadvertently only the perilesional area and adjacent cortex had been resected.The patient underwent a new surgical procedure where the ganglioglioma was removed,and the status epilepticus cessated.Conclusions This clinical case suggests that the lesion itself plays an important role in seizure generation and propagation,and notably,that the surrounding cortex by an inhibitory action can act as a gate to seizure spread.
