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Abstract：
Background Patients with drug-resistant epilepsy commonly undergo stereo-electroencephalography (SEEG) intracranial monitoring for surgical evaluation. Our current practice of defining the epileptogenic zone relies heavily on recognizing the seizure onset zone (SOZ), but the clinical significance of interictal epileptiform discharges (IEDs) is not well established. Methodology We retrospectively identified adult patients who underwent SEEG between January 2019 and May 2022. To study IED activation patterns, we classified IEDs as leading spikes (involved within the SOZ) and distant spikes (outside the SOZ). We calculated each patient\'s total number of brain subregions generating distant spikes. We correlated them with epilepsy type, duration, and surgical outcome (Engel I: good outcome and Engel II-IV: poor outcome). Results A total of 22 patients were identified during the study period, and 16 underwent surgical intervention (ablation or resection) with one-year post-surgery follow-up. The most common IED morphology was a single spike or sharp followed by periodic spikes or sharps. We found that 87% (n = 19/22) of leading spikes were activated during the first 24 hours of SEEG monitoring, whereas no activation pattern was observed for distant spikes. We found that a higher number of subregions generating distant spikes were associated with poor surgical outcomes (p = 0.002). However, we did not find any significant association between the number of subregions generating distant spikes with epilepsy duration (p = 0.67), temporal or extratemporal-onset epilepsy (p = 0.58), or the presence of an MRI lesion (p = 0.62). Conclusions IEDs involved within the SOZ were found to be activated during the first 24 hours of SEEG monitoring, which could aid in recognizing the pathological spikes and targeted mapping of the irritative zone. We also observed that a higher number of brain subregions generating IEDs outside the SOZ were associated with poor surgical outcomes, but this observation needs to be further studied with larger sample size prospective studies.
摘要：
背景耐药癫痫患者通常接受立体脑电图（SEEG）颅内监测以进行手术评估。我们目前定义癫痫发生区的做法在很大程度上依赖于识别癫痫发作区（SOZ），但发作间癫痫样放电(IEDs)的临床意义尚不明确.方法我们回顾性地确定了在2019年1月至2022年5月期间接受SEEG的成年患者。为了研究简易爆炸装置的激活模式，我们将IED分类为领先的尖峰(涉及SOZ内)和遥远的尖峰(SOZ外)。我们计算了每个患者产生远距尖峰的大脑子区域的总数。我们将它们与癫痫类型相关联，持续时间,和手术结果（恩格尔I：好的结果和恩格尔II-IV：差的结果）。结果在研究期间共发现22例患者,16例接受了手术干预(消融或切除),术后1年随访.最常见的IED形态是单个尖峰或尖锐，然后是周期性尖峰或尖锐。我们发现，在SEEG监测的前24小时内，有87％（n=19/22）的前导尖峰被激活，而远处尖峰没有观察到激活模式。我们发现，产生远处尖峰的子区域数量较多与不良的手术结果相关（p=0.002）。然而,我们没有发现产生远距尖峰的亚区域数量与癫痫持续时间之间有任何显著关联（p=0.67），颞部或颞外发作性癫痫（p=0.58），或存在MRI病变（p=0.62）。结论在SEEG监测的最初24小时内，发现SOZ中涉及的IED被激活，这可以帮助识别病理尖峰和刺激区的有针对性的映射。我们还观察到，在SOZ之外产生IED的脑亚区域数量较多，与不良的手术结果相关。但这一观察结果需要通过更大样本量的前瞻性研究进一步研究.
