Abstract：
BACKGROUND: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) develops along with status epilepticus and widespread subcortical white matter edema. We aimed to evaluate the epileptic foci and networks in two patients with epilepsy after AESD using simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI).
METHODS: Statistically significant blood oxygen level-dependent (BOLD) responses related to interictal epileptiform discharges (IEDs) were analyzed using an event-related design of hemodynamic response functions with multiple peaks.
RESULTS: Patient 1 developed focal seizures at age 10 years, one year after AESD onset. Positive BOLD changes were observed in the bilateral frontotemporal lobes, left parietal lobe, and left insula. BOLD changes were also observed in the subcortical structures. Patient 2 developed epileptic spasms at age two years, one month after AESD onset. Following total corpus callosotomy (CC) at age three years, the epileptic spasms resolved, and neurodevelopmental improvement was observed. Before CC, positive BOLD changes were observed bilaterally in the frontotemporal lobes. BOLD changes were also observed in the subcortical structures. After CC, the positive BOLD changes were localized in the temporal lobe ipsilateral to the IEDs, and the negative BOLD changes were mainly in the cortex and subcortical structures of the hemisphere ipsilateral to IEDs.
CONCLUSIONS: EEG-fMRI revealed multiple epileptic foci and extensive epileptic networks, including subcortical structures in two cases with post-AESD epilepsy. CC may be effective in disconnecting the bilaterally synchronous epileptic networks of epileptic spasms after AESD, and pre-and post-operative changes in EEG-fMRI may reflect improvements in epileptic symptoms.
METHODS: Statistically significant blood oxygen level-dependent (BOLD) responses related to interictal epileptiform discharges (IEDs) were analyzed using an event-related design of hemodynamic response functions with multiple peaks.
RESULTS: Patient 1 developed focal seizures at age 10 years, one year after AESD onset. Positive BOLD changes were observed in the bilateral frontotemporal lobes, left parietal lobe, and left insula. BOLD changes were also observed in the subcortical structures. Patient 2 developed epileptic spasms at age two years, one month after AESD onset. Following total corpus callosotomy (CC) at age three years, the epileptic spasms resolved, and neurodevelopmental improvement was observed. Before CC, positive BOLD changes were observed bilaterally in the frontotemporal lobes. BOLD changes were also observed in the subcortical structures. After CC, the positive BOLD changes were localized in the temporal lobe ipsilateral to the IEDs, and the negative BOLD changes were mainly in the cortex and subcortical structures of the hemisphere ipsilateral to IEDs.
CONCLUSIONS: EEG-fMRI revealed multiple epileptic foci and extensive epileptic networks, including subcortical structures in two cases with post-AESD epilepsy. CC may be effective in disconnecting the bilaterally synchronous epileptic networks of epileptic spasms after AESD, and pre-and post-operative changes in EEG-fMRI may reflect improvements in epileptic symptoms.
摘要：
背景：伴有双相性癫痫发作和晚期弥散减少（AESD）的急性脑病与癫痫持续状态和广泛的皮质下白质水肿一起发展。我们旨在使用同时脑电图和功能磁共振成像（EEG-fMRI）评估AESD后两名癫痫患者的癫痫灶和网络。
方法：使用具有多个峰值的血液动力学反应功能的事件相关设计，分析了与发作间癫痫样放电（IED）相关的具有统计学意义的血氧水平依赖性（BOLD）反应。
结果：患者1在10岁时出现局灶性癫痫发作，AESD发病后一年。在双侧额颞叶观察到阳性BOLD变化，左顶叶,离开脑岛。在皮质下结构中也观察到BOLD变化。患者2岁时出现癫痫性痉挛，AESD发病后一个月。在三岁时进行全骨体切开术（CC）后，癫痫痉挛消退了,观察到神经发育改善。在CC之前,额颞叶双侧观察到BOLD正变化。在皮质下结构中也观察到BOLD变化。在CC之后,阳性BOLD变化位于IED同侧的颞叶，阴性BOLD变化主要在IED同侧半球的皮质和皮质下结构中。
结论：EEG-fMRI显示多个癫痫灶和广泛的癫痫网络，包括2例AESD后癫痫患者的皮质下结构。CC可以有效地断开AESD后癫痫痉挛的双侧同步癫痫网络，手术前后EEG-fMRI的变化可能反映了癫痫症状的改善。
方法：使用具有多个峰值的血液动力学反应功能的事件相关设计，分析了与发作间癫痫样放电（IED）相关的具有统计学意义的血氧水平依赖性（BOLD）反应。
结果：患者1在10岁时出现局灶性癫痫发作，AESD发病后一年。在双侧额颞叶观察到阳性BOLD变化，左顶叶,离开脑岛。在皮质下结构中也观察到BOLD变化。患者2岁时出现癫痫性痉挛，AESD发病后一个月。在三岁时进行全骨体切开术（CC）后，癫痫痉挛消退了,观察到神经发育改善。在CC之前,额颞叶双侧观察到BOLD正变化。在皮质下结构中也观察到BOLD变化。在CC之后,阳性BOLD变化位于IED同侧的颞叶，阴性BOLD变化主要在IED同侧半球的皮质和皮质下结构中。
结论：EEG-fMRI显示多个癫痫灶和广泛的癫痫网络，包括2例AESD后癫痫患者的皮质下结构。CC可以有效地断开AESD后癫痫痉挛的双侧同步癫痫网络，手术前后EEG-fMRI的变化可能反映了癫痫症状的改善。
