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Abstract：
To analyze the influence of seizure semiology, electroencephalography (EEG) features and magnetic resonance imaging (MRI) change on epileptogenic zone localization and surgical prognosis in children with epileptic spasm (ES) were assessed. Data from 127 patients with medically intractable epilepsy with ES who underwent surgical treatment were retrospectively analyzed. ES semiology was classified as non-lateralized, bilateral asymmetric, and focal. Interictal epileptiform discharges were divided into diffusive or multifocal, unilateral, and focal. MRI results showed visible local lesions for all patients, while the anatomo-electrical-clinical value of localization of the epileptogenic zone was dependent on the surgical outcome. During preoperative video EEG monitoring, among all 127 cases, 53 cases (41.7%) had ES only, 46 (36.2%) had ES and focal seizures, 17 (13.4%) had ES and generalized seizures, and 11 (8.7%) had ES with focal and generalized seizures. Notably, 35 (27.6%) and 92 cases (72.4%) showed simple and complex ES, respectively. Interictal EEG showed that 22 cases (17.3%) had bilateral multifocal discharges or hypsarrhythmia, 25 (19.7%) had unilateral dominant discharges, and 80 (63.0%) had definite focal or regional discharges. Ictal discharges were generalized/bilateral in 71 cases (55.9%) and definite/lateralized in 56 cases (44.1%). Surgically resected lesions were in the hemisphere (28.3%), frontal lobe (24.4%), temporal lobe (16.5%), temporo-parieto-occipital region (14.2%), and posterior cortex region (8.7%). Seizure-free rates at 1 and 4 years postoperatively were 81.8 and 72.7%, respectively. There was no significant difference between electroclinical characteristics of ES and seizure-free rate. Surgical treatment showed good outcomes in most patients in this cohort. Semiology and ictal EEG change of ES had no effect on localization, while focal or lateralized epileptiform discharges of interictal EEG may affect lateralization and localization. Complete resection of epileptogenic lesions identified via MRI was the only factor associated with a positive surgical outcome.
摘要：
为了分析癫痫发作符号学的影响，评估了癫痫性痉挛（ES）患儿的脑电图（EEG）特征和磁共振成像（MRI）改变对癫痫发生区定位和手术预后的影响。回顾性分析了127例接受手术治疗的难治性癫痫伴ES患者的数据。ES符号学被归类为非横向化，双边不对称，和焦点。发作间癫痫样放电分为弥漫性或多灶性，单边,和焦点。MRI结果显示所有患者可见局部病灶,而癫痫发生区定位的解剖-电-临床价值取决于手术结果。在术前视频脑电图监测期间，在所有127例病例中，53例（41.7％）仅患有ES，46人（36.2%）有ES和局灶性癫痫发作，17人（13.4%）患有ES和全身性癫痫发作，11例(8.7%)有ES伴局灶性和全身性癫痫发作.值得注意的是,35例(27.6%)和92例(72.4%)显示简单和复杂的ES，分别。发作间脑电图显示22例(17.3%)有双侧多灶性放电或心律失常,25人(19.7%)有单方面主导排放，80例(63.0%)有明确的局灶性或区域性放电。71例（55.9％）和56例（44.1％）的明确/侧方出院。手术切除的病灶位于半球（28.3%），额叶（24.4%），颞叶（16.5%），颞顶枕区（14.2%），和后皮质区(8.7%)。术后1年和4年无癫痫发生率分别为81.8％和72.7％，分别。ES的电临床特征与无癫痫发作率之间没有显着差异。在该队列中，大多数患者的手术治疗结果良好。ES的符号学和发作脑电图变化对定位没有影响，而发作间脑电图的局灶性或侧向癫痫样放电可能会影响侧向化和定位。通过MRI确定的癫痫灶的完全切除是与阳性手术结果相关的唯一因素。
