Abstract
Objective
The aim of this study was to investigate the different ictal onset stereoelectroencephalography patterns (IOPs) in patients with drug-resistant temporal lobe epilepsy (TLE). We examined whether the IOPs relate to different TLE subtypes, MRI findings, and underlying pathologies, and we evaluated their prognostic value for predicting the surgical outcome.
Methods
We retrospectively analyzed data from patients with TLE who underwent stereoelectroencephalography (SEEG) monitoring followed by surgical resection between January 2018 and January 2020. The SEEG recordings were independently analyzed by two epileptologists.
Results
Forty-five patients were included in the study, and 61seizures were analyzed. Five IOPs were identified: low voltage fast activity (LVFA; 44.3%), spike-and-wave activity (16.4%), low frequency high-amplitude periodic spikes (LFPS; 18%), a burst of high-amplitude polyspikes (8.2%), and rhythmic sharp activity at ≤ 13 Hz (13.1%). Thirty-two patients were found to have a single IOP, while the other 13 patients had two or more IOPs. All five IOPs were found to occur in the medial temporal lobe epilepsy (MTLE), while four IOPs occurred in the lateral temporal lobe epilepsy (LTLE). The LFPS was a common IOP that could distinguish MTLE from LTLE (x2 = 7.046, p = 0.011). Among the MTLE patients, the LFPS was exclusively seen in cases of hippocampal sclerosis (x2 = 5.058, p = 0.038), while the LVFA was associated with nonspecific histology (x2 = 6.077, p = 0.023). The IOPs were not found to differ according to whether the MRI scans were positive or negative. After surgery, patients achieved the higher seizure-free rate at 81.8% and 77.8%, respectively, if the LFPS and LVFA were the predominant patterns. Multiple IOPs or a negative MRI did not indicate a poor prognosis.
Conclusions
Five distinct IOPs were identified in the patients with TLE. The differences found have important clinical implications and could provide complementary information for surgical decision-making, especially in MRI-negative patients.
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Acknowledgements
We thank Jessica Foxton, PhD, from Liwen Bianji (Edanz) (www.liwenbianji.cn/) for editing the English text of a draft of this manuscript.
Funding
The study was supported by grants from Bei**g Natural Science Foundation (L182015), Bei**g Hospitals Authority Ascent Plan (DFL20190801), Capital Health Research and Development of Special Project (2020–1-2013).
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This study was approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University, China, according to the Declaration of Helsinki. Informed consent was obtained from all patients or their guardians.
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Comments
Nice retrospective study from a large volume epilepsy surgical center demonstrating how stereoencephalograpy recording of ictal onset patterns in temporal lope epilepsy may distinguish between MTLE and LTLE and support surgical success prognostication.
Carsten Reidies Bjarkam
Aalborg, Denmark
This article is part of the Topical Collection on Functional Neurosurgery — Epilepsy
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Cui, D., Gao, R., Xu, C. et al. Ictal onset stereoelectroencephalography patterns in temporal lobe epilepsy: type, distribution, and prognostic value. Acta Neurochir 164, 555–563 (2022). https://doi.org/10.1007/s00701-022-05122-z
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DOI: https://doi.org/10.1007/s00701-022-05122-z