目的:用颅内电极记录的高频振荡(HFO;波纹80-250Hz;快速波纹[FR]250-500Hz)引起兴奋,并争论其定位癫痫灶的潜力。我们对颅内脑电图(iEEG)进入多个亚组时完全切除HFOs区(crHFOs区)对癫痫手术结果的预后价值进行了系统评价和荟萃分析。
方法:我们搜索了PubMed,Embase,和WebofScience从开始到2022年10月27日的原始研究。我们将有利的手术结果(FSO)定义为EngelI类,国际抗癫痫联盟1级或无癫痫状态。通过(1)crHFOs面积后的合并FSO比例评估crHFOs面积对FSO的预后价值;(2)crHFOs面积与无crHFOs面积的FSO;(3)预测性能。我们将高联合预后价值定义为FSO比例>80%+FSOcrHFOs-面积>无crHFOs-面积+曲线下面积(AUC)>0.75,并对临床亚组进行了检查(研究设计,年龄,诊断类型,HFOs识别方法,HFOs速率阈值,和iEEG状态)。通过二分类变量分析将颞叶癫痫(TLE)与TLE外癫痫进行比较。对患者的性别进行了个体分析,受影响的半球,MRI检查结果,手术位置,和病理学。
结果:在筛选的1,387项研究中,31项研究(703名患者)符合我们的资格标准。27项研究(602名患者)分析了FR和20项研究(424名患者)涟漪。CRHFOs面积后的集合FSO比例为FR的81%(95%CI76%-86%),波纹的比例为82%(73%-89%)。具有crHFOs面积的患者比没有crHFOs面积的患者更容易获得FSO(FRs优势比[OR]6.38,4.03-10.09,p<0.001;波纹4.04,2.32-7.04,p<0.001)。FR的合并AUC为0.81(0.77-0.84),波纹为0.76(0.72-0.79)。10个亚组的综合预后价值较高:回顾性,孩子们,长期iEEG,阈值(FR和波纹)和自动检测和发作间(FR)。与TLE患者相比,TLE患者完全切除FR区(crFR区)后获得FSO的频率较低(OR0.37,0.15-0.89,p=0.006)。个体患者分析表明,有FSO的患者比没有MRI病变的患者更多(多次校正后p=0.02)。
结论:完全切除HFOs脑区与良好的术后预后相关。其预后价值成立,特别是对于FR,对于各种子组。对于TLE外患者使用HFOs需要进一步的证据。
OBJECTIVE: High-frequency oscillations (HFOs; ripples 80-250 Hz; fast ripples [FRs] 250-500 Hz) recorded with intracranial electrodes generated excitement and debate about their potential to localize epileptogenic foci. We performed a systematic
review and meta-analysis on the prognostic value of complete resection of the HFOs-area (crHFOs-area) for epilepsy surgical outcome in intracranial EEG (iEEG) accessing multiple subgroups.
METHODS: We searched PubMed, Embase, and Web of Science for original research from inception to October 27, 2022. We defined favorable surgical outcome (FSO) as Engel class I, International League Against Epilepsy class 1, or seizure-free status. The prognostic value of crHFOs-area for FSO was assessed by (1) the pooled FSO proportion after crHFOs-area; (2) FSO for crHFOs-area vs without crHFOs-area; and (3) the predictive performance. We defined high combined prognostic value as FSO proportion >80% + FSO crHFOs-area >without crHFOs-area + area under the curve (AUC) >0.75 and examined this for the clinical subgroups (study design, age, diagnostic type, HFOs-identification method, HFOs-rate thresholding, and iEEG state). Temporal lobe epilepsy (TLE) was compared with extra-TLE through dichotomous variable analysis. Individual patient analysis was performed for sex, affected hemisphere, MRI findings, surgery location, and pathology.
RESULTS: Of 1,387 studies screened, 31 studies (703 patients) met our eligibility criteria. Twenty-seven studies (602 patients) analyzed FRs and 20 studies (424 patients) ripples. Pooled FSO proportion after crHFOs-area was 81% (95% CI 76%-86%) for FRs and 82% (73%-89%) for ripples. Patients with crHFOs-area achieved more often FSO than those without crHFOs-area (FRs odds ratio [OR] 6.38, 4.03-10.09, p < 0.001; ripples 4.04, 2.32-7.04, p < 0.001). The pooled AUCs were 0.81 (0.77-0.84) for FRs and 0.76 (0.72-0.79) for ripples. Combined prognostic value was high in 10 subgroups: retrospective, children, long-term iEEG, threshold (FRs and ripples) and automated detection and interictal (FRs). FSO after complete resection of FRs-area (crFRs-area) was achieved less often in people with TLE than extra-TLE (OR 0.37, 0.15-0.89, p = 0.006). Individual patient analyses showed that crFRs-area was seen more in patients with FSO with than without MRI lesions (p = 0.02 after multiple correction).
CONCLUSIONS: Complete resection of the brain area with HFOs is associated with good postsurgical outcome. Its prognostic value holds, especially for FRs, for various subgroups. The use of HFOs for extra-TLE patients requires further evidence.