Evaluating The Localization Roles Of The Scalp EEG And Intraoperative ECoG In Surgical Treatment Of The Temporal Lobe Epilepsy

Objective: Temporal lobe epilepsy is the most common intractable epilepsy,while sugery is an effective method to treat this diease.The prognosis will be improved by precisely localizing and removing the seizure onset zone.The scalp electroencephalography(EEG)and intraoperative electrocoticography(ECoG)are very important in the preoperative evaluation of the temporal lobe epilepsy(TLE).The localization role of the intraoperative ECoG with 32 electrode system is unclear.The study intended to figure out the meaning of these result in localization of the seizure onset zone by analysing the results of the preoperative scalp EEG and the acute intraoperative ECoG.Methods: Though retrospective research of the temporal lobe epilepsy patients in the Third Functional Neurosurgery Department affiliated to China Medical University from 2013 to 2017.The patients who were diagnosed temporal lobe epilepsy by scalp EEG,also did intraoperative ECoG evaluation with 32 electrode system was included.We categorized the patients according to their electroclinical data,Outcomes was divided into excellent group and non-excellent group evaluated through Engel classification.Engel class I means outcome excellent and Engel II-IV separated to non-excellent group.Results: Fifty-one patients met the inclusion criteria.Thirty-six(70.6%)reached excellent outcome.The epileptiform activity only arising from the mesial part of the temporal lobe in intraoperative ECoG(P=.021),which both have analytical meanings with the surgery outcome.Three patients did the long-time EEG monitoring(LTM)for the unclearing result of the acute ECoG,before the lesionectomy operation.Among the three patients,two patients had an excellent outcome.Conclusion: The ictal epileptiform activity arising from ipsilateral temporal lobe in scalp EEG evaluation and that from the mesial part of the temporal lobe in intraoperative ECoG,which both have better surgery outcome.The intraoperative ECoG with 32 electrode system was important in localization before the lesionectomy operation,especially for the temporal lobe patients with widespread discharge in scalp EEG.When the acute electrocoticography monitoring can’t localizing the SOZ precisely,the LTM will be alternative.Then the operative was followed.