PDF(Pubmed)
Abstract：
Achieving seizure freedom following failure of several antiseizure medications (ASMs) is rare, with the likelihood of achieving further control decreasing with each successive ASM trial. When cases of drug-resistant epilepsy arise, a diagnostic procedure known as stereoelectroencephalography (sEEG) can be used to identify epileptogenic zones (EZ) within the brain. After localization of these zones, they can be targeted for future surgical intervention. Here, we describe a case of complete seizure freedom off medication after sEEG without resection or other therapeutic intervention. In 2017, a 36-year-old right-handed male presented with drug-resistant epilepsy stemming from prior traumatic brain injury. Due to ongoing seizures, in 2020 a robotic-assisted sEEG electrode placement procedure was employed to localize the seizure onset zone. During sEEG monitoring, a single event was captured where the patient had dysarthric speech, left arm dystonic flexion, and difficulty responding to questioning. Notably, this event had no sEEG correlate, suggesting seizure occurrence in a region not monitored by implanted electrodes, which prompted the placement of scalp electrodes following this event. However, no further clinical events consistent with seizure were provoked through the remainder of recording. Following the 13-day admission, the patient chose to self-discontinue all seizure medications and has remained seizure free as of October 2023, more than 3.5 years later. While sEEG is considered a relatively safe procedure for seizure localization in drug resistant epilepsy, the possibility of microlesions created by sEEG depth electrodes remains largely unexplored. Further evaluation should be performed into potential tissue injury produced by depth electrode insertion.
摘要：
在几种抗癫痫药物（ASM）失败后实现癫痫发作的自由是罕见的，每个连续的ASM试验实现进一步控制的可能性降低。当出现耐药癫痫时，称为立体脑电图（sEEG）的诊断程序可用于识别脑内的癫痫区（EZ）。这些区域本地化后，它们可以成为未来手术干预的目标。这里,我们描述了一例在没有切除或其他治疗性干预的情况下，在sEEG后完全无药物治疗的情况。2017年，一名36岁的右撇子男性因先前的创伤性脑损伤而出现耐药性癫痫。由于持续的癫痫发作，2020年,采用机器人辅助的sEEG电极放置程序定位癫痫发作区.在sEEG监测期间，一个事件被捕获，病人有障碍的言语，左臂肌张力障碍屈曲,难以回应提问。值得注意的是,此事件与sEEG无关，提示癫痫发作发生在未被植入电极监测的区域，这促使在此事件后放置头皮电极。然而,在其余记录中,未引发与癫痫发作一致的进一步临床事件.经过13天的录取，患者选择自行停用所有癫痫发作药物,且在超过3.5年后的2023年10月仍未出现癫痫发作.虽然sEEG被认为是耐药癫痫发作定位的相对安全的程序，sEEG深度电极产生微病变的可能性仍未被探索。应进一步评估由深度电极插入产生的潜在组织损伤。
