Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy

被引:2
作者
Irannejad, Auriana [1 ,2 ]
Chaitanya, Ganne [1 ,2 ]
Toth, Emilia [1 ,2 ]
Pizarro, Diana [1 ,2 ]
Pati, Sandipan [1 ,2 ,3 ]
机构
[1] Univ Alabama Birmingham, Dept Neurol, Birmingham, AL 35294 USA
[2] Univ Alabama Birmingham, Epilepsy & Cognit Neurophysiol Lab, Birmingham, AL 35294 USA
[3] McGovern Med Sch, Texas Comprehens Epilepsy Ctr, Epilepsy & Cognit Neurophysiol Lab, Dept Neurol, Houston, TX 77030 USA
来源
FRONTIERS IN NEUROLOGY | 2022年 / 12卷
关键词
direct cortical stimulation; seizure onset zone; ictogenicity; temporal lobe epilepsy; epileptogenicity; HIGH-FREQUENCY OSCILLATIONS; ELECTRICAL-STIMULATION; ONSET PATTERNS; SURGERY; LOCALIZATION; BIOMARKERS; NETWORKS; BRAIN;
D O I
10.3389/fneur.2021.761412
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Accurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SOZ for particular electrographic seizure onset patterns. Therefore, using direct cortical stimulation (DCS) as a probing tool to identify seizure generators, we systematically evaluated the causality of the high EI nodes (>0.3) in replicating the patient's habitual seizures. Specifically, we assessed the diagnostic yield of high EI nodes, i.e., the proportion of high EI nodes that evoked habitual seizures. A retrospective single-center study that included post-stereo encephalography (SEEG) confirmed TLE patients (n = 37) that had all high EI nodes stimulated, intending to induce a seizure. We evaluated the nodal responses (true and false responder rate) to stimulation and correlated with electrographic seizure onset patterns (hypersynchronous-HYP and low amplitude fast activity patterns-LAFA) and clinically defined SOZ. The ictogenicity (i.e., the propensity to induce the patient's habitual seizure) of a high EI node was only 44.5%. The LAFA onset pattern had a significantly higher response rate to DCS (i.e., higher evoked seizures). The concordance of an evoked habitual seizure with a clinically defined SOZ with good outcomes was over 50% (p = 0.0025). These results support targeted mapping of SOZ in LAFA onset patterns by performing DCS in high EI nodes to distinguish seizure generators (true responders) from hyperexcitable nodes that may be involved in early propagation.
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页数:10
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