Abstract：
OBJECTIVE: To describe the association between preoperative ictal scalp electroencephalogram (EEG) results and surgical outcomes in patients with focal epilepsies.
METHODS: The data of consecutive patients with focal epilepsies who received surgical treatments at our center from January 2012 to December 2021 were retrospectively analyzed.
RESULTS: Our data showed that 44.2% (322/729) of patients had ictal EEG recorded on video EEG monitoring during preoperative evaluation, of which 60.6% (195/322) had a concordant ictal EEG results. No significant difference of surgery outcomes between patients with and without ictal EEG was discovered. Among MRI-negative patients, those with concordant ictal EEG had a significantly better outcome than those without ictal EEG (75.7% vs. 43.8%, p = 0.024). Further logistic regression analysis showed that concordant ictal EEG was an independent predictor for a favorable outcome (OR = 4.430, 95%CI 1.175-16.694, p = 0.028). Among MRI-positive patients, those with extra-temporal lesions and discordant ictal EEG results had a worse outcome compared to those without an ictal EEG result (44.7% vs. 68.8%, p = 0.005). Further logistic regression analysis showed that discordant ictal EEG was an independent predictor of worse outcome (OR = 0.387, 95%CI 0.186-0.807, p = 0.011) in these patients. Furthermore, our data indicated that the number of seizures was not associated with the concordance rates of the ictal EEG, nor the surgical outcomes.
CONCLUSIONS: The value of ictal scalp EEG for epilepsy surgery varies widely among patients. A concordant ictal EEG predicts a good surgical outcome in MRI-negative patients, whereas a discordant ictal EEG predicts a poor postoperative outcome in lesional extratemporal lobe epilepsy.
METHODS: The data of consecutive patients with focal epilepsies who received surgical treatments at our center from January 2012 to December 2021 were retrospectively analyzed.
RESULTS: Our data showed that 44.2% (322/729) of patients had ictal EEG recorded on video EEG monitoring during preoperative evaluation, of which 60.6% (195/322) had a concordant ictal EEG results. No significant difference of surgery outcomes between patients with and without ictal EEG was discovered. Among MRI-negative patients, those with concordant ictal EEG had a significantly better outcome than those without ictal EEG (75.7% vs. 43.8%, p = 0.024). Further logistic regression analysis showed that concordant ictal EEG was an independent predictor for a favorable outcome (OR = 4.430, 95%CI 1.175-16.694, p = 0.028). Among MRI-positive patients, those with extra-temporal lesions and discordant ictal EEG results had a worse outcome compared to those without an ictal EEG result (44.7% vs. 68.8%, p = 0.005). Further logistic regression analysis showed that discordant ictal EEG was an independent predictor of worse outcome (OR = 0.387, 95%CI 0.186-0.807, p = 0.011) in these patients. Furthermore, our data indicated that the number of seizures was not associated with the concordance rates of the ictal EEG, nor the surgical outcomes.
CONCLUSIONS: The value of ictal scalp EEG for epilepsy surgery varies widely among patients. A concordant ictal EEG predicts a good surgical outcome in MRI-negative patients, whereas a discordant ictal EEG predicts a poor postoperative outcome in lesional extratemporal lobe epilepsy.
摘要：
目的：描述局灶性癫痫患者术前头皮脑电图（EEG）结果与手术结果之间的关系。
方法：回顾性分析2012年1月至2021年12月在我中心接受手术治疗的连续局灶性癫痫患者的资料。
结果：我们的数据显示，在术前评估期间，有44.2％（322/729）的患者在视频脑电图监测中记录了发作脑电图，其中60.6%(195/322)的脑电图结果一致。有和没有发作脑电图的患者之间的手术结果没有显着差异。在MRI阴性患者中，具有一致发作脑电图的患者的预后明显优于没有发作脑电图的患者（75.7％vs.43.8%,p=0.024)。进一步的逻辑回归分析显示，一致的脑电图是有利结局的独立预测因素（OR=4.430，95CI1.175-16.694，p=0.028）。在MRI阳性患者中，与没有发作性脑电图结果的患者相比，颞外病变和发作性脑电图结果不一致的患者的结果更差(44.7%vs.68.8%,p=0.005)。进一步的逻辑回归分析显示，不一致的脑电图是这些患者预后较差的独立预测因素（OR=0.387，95CI0.186-0.807，p=0.011）。此外，我们的数据表明，癫痫发作次数与脑电图的一致率无关，也不是手术结果。
结论：发作性头皮脑电图对癫痫手术的价值在患者中差异很大。一致的脑电图预测MRI阴性患者的良好手术结果，而不一致的发作脑电图预测颞外叶病灶性癫痫的术后预后不良。
方法：回顾性分析2012年1月至2021年12月在我中心接受手术治疗的连续局灶性癫痫患者的资料。
结果：我们的数据显示，在术前评估期间，有44.2％（322/729）的患者在视频脑电图监测中记录了发作脑电图，其中60.6%(195/322)的脑电图结果一致。有和没有发作脑电图的患者之间的手术结果没有显着差异。在MRI阴性患者中，具有一致发作脑电图的患者的预后明显优于没有发作脑电图的患者（75.7％vs.43.8%,p=0.024)。进一步的逻辑回归分析显示，一致的脑电图是有利结局的独立预测因素（OR=4.430，95CI1.175-16.694，p=0.028）。在MRI阳性患者中，与没有发作性脑电图结果的患者相比，颞外病变和发作性脑电图结果不一致的患者的结果更差(44.7%vs.68.8%,p=0.005)。进一步的逻辑回归分析显示，不一致的脑电图是这些患者预后较差的独立预测因素（OR=0.387，95CI0.186-0.807，p=0.011）。此外，我们的数据表明，癫痫发作次数与脑电图的一致率无关，也不是手术结果。
结论：发作性头皮脑电图对癫痫手术的价值在患者中差异很大。一致的脑电图预测MRI阴性患者的良好手术结果，而不一致的发作脑电图预测颞外叶病灶性癫痫的术后预后不良。
