Abstract：
Progressive inflammation of one hemisphere characterises Rasmussen\'s encephalitis (RE), but contralesional epileptiform activity has been repeatedly reported. We aimed to quantify contralesional epileptiform activity in RE and uncover its functional and structural underpinnings. We retrospectively ascertained people with RE treated between 2000 and 2018 at a tertiary centre (Centre 1) and reviewed all available EEG datasets. The temporal occurrence of preoperative contralesional epileptiform activity (interictal/ictal) was evaluated using mixed-effects logistic regression. Cases with/without contralesional epileptiform activity were compared for cognition, inflammation (ipsilesional brain biopsies), and MRI (cortical and fixel-based morphometry). EEG findings were validated in a second cohort treated at another tertiary centre (Centre 2) between 1995 and 2020. We included 127 people with RE and 687 EEG samples. Preoperatively, contralesional epileptiform activity was seen in 30/68 (44%, Centre 1) and 8/59 (14%, Centre 2). In both cohorts, this activity was associated with younger onset age (OR = 0.9; 95% CI 0.83-0.97; P = 0.006). At centre 1, contralesional epileptiform activity was associated with contralesional MRI alterations, lower intelligence (OR = 5.19; 95% CI 1.28-21.08; P = 0.021), and impaired verbal memory (OR = 10.29; 95% CI 1.97-53.85; P = 0.006). After hemispherotomy, 11/17 (65%, Centre 1) and 28/37 (76%, Centre 2) were seizure-free. Contralesional epileptiform activity was persistent postoperatively in 6/12 (50%, Centre 1) and 2/34 (6%, Centre 2). Preoperative contralesional epileptiform activity reduced the chance of postoperative seizure freedom in both cohorts (OR = 0.69; 95% CI 0.50-0.95; P = 0.029). Our findings question the concept of strict unilaterality of RE and provide the evidence of contralesional epileptiform activity as a possible EEG predictor for persisting postoperative seizures.
摘要：
一个半球的进行性炎症表征拉斯穆森脑炎（RE），但已反复报道了对比灶癫痫样活动。我们旨在量化RE的对侧癫痫样活动，并揭示其功能和结构基础。我们回顾性地确定了2000年至2018年在三级中心（中心1）接受治疗的RE患者，并回顾了所有可用的EEG数据集。使用混合效应逻辑回归评估术前对侧癫痫样活动（发作间/发作间）的时间发生。比较有/没有对比灶癫痫样活动的病例的认知，炎症（脑活检），和MRI（皮质和基于固定的形态学）。在1995年至2020年之间在另一个三级中心（中心2）治疗的第二个队列中验证了EEG发现。我们包括127名RE患者和687例EEG样本。术前,对比性癫痫样活动见于30/68（44%，中心1)和8/59(14%，中心2）。在这两个队列中，该活动与发病年龄较低相关(OR=0.9;95%CI0.83-0.97;P=0.006).在中心1，对侧癫痫样活动与对侧MRI改变有关，智力较低(OR=5.19；95%CI1.28-21.08；P=0.021)，和言语记忆受损(OR=10.29;95%CI1.97-53.85;P=0.006)。大脑半球切开术后,11/17（65%，中心1)和28/37(76%，中心2）无癫痫发作。对比性癫痫样活动在术后6/12持续(50%，中心1)和2/34(6%，中心2）。术前对比灶癫痫样活动减少了两组患者术后癫痫发作的机会(OR=0.69;95%CI0.50-0.95;P=0.029)。我们的发现质疑RE的严格单方面性的概念，并提供了对比灶癫痫样活动作为持续术后癫痫发作的可能脑电图预测因子的证据。
