| Objective To investigate the specialty of both the scalp EEG(sEEG) and intracranial EEG(iEEG)in the epilepsy surgical treatment, and analyse the accuracy of the sEEG in the frontal lobe,temporal lobe and parietal-occipital lobe epilepsy. Finally, figure out that in what kind ofepilepsy, sEEG can localize the epileptogenic zone accurately in order to replace the iEEG.Methods 29 patients with intractable epilepsy, received inpatient scalp vEEG monitoring for 1-2weeks, then captured the EEG of clinical seizures and interictal seizures. According toperformances of scalp vEEG and MRI, the locations of intracranid eletrodes (subdural and/ordepth eletrodes)were determined, and at least 3 habitual seizures were recorded. Finally,comparing the accuracy of sEEG in different brain lobe on the basis of iEEG.Results1. Among the 29 patients reported in this paper, the probability of the scalp EEG locating thefrontal lobe epileptic foci was 84.2%, and Kappa value was -0.02, so the reliability was low;however, the probability of the scalp EEG locating epileptogenic zone in temporal lobe was93.3%, and the Kappa value was 0.5 with the high reliability. 3 cases of parietal - occipital lobeepilepsy, sEEG can locate the epileptogenic zone, which was the same with iEEG.2. After more than one year's patients following-up, long-time outcome classification wasperformed with the modified Engel scale. 8 of 10 patients with temporal lobe epilepsy were up toclassâ… (80%), other 2 patients were up to classâ…¡(20%). 8 of 16 patients with frontal lobeepilepsy were up to classâ… (50%), 5 patients were up to classâ…¡(31.2%), other 3 patients were upto classâ…¢(18.8%). 3 patients with parietal - occipital lobe epilepsy were all up to classâ… .3. All patients undergone V-EEG monitoring after the surgery of 3 , 6 and 12months. 9 of 10patients with temporal lobe epilepsy had obvious improvement on EEG (epilepsy dischargedisappeared or reduced after surgery), one of patients also had epilepsy discharge on the lobeopposite the epileptogenic zone. 5 of 16 patients with frontal lobe epilepsy had obviousimprovement on EEG , the epilepsy discharge index of 7 patients reduced more than 50%, 4patients reduced less than 50%. 3 patients with parietal - occipital lobe epilepsy had obviousimprovement on EEG.4.4 of 10 patients with temporal lobe epilepsy stopped taking drugs after the surgery, and theother 6 patients reduced the dose after the surgery; 16 patients with frontal lobe epilepsy stilltook the drugs, few of them using drugs were less than preoperative; 3 patients with parietal - occipital lobe epilepsy reduced the doses less than preoperative.Conclusionclusion sEEG has a higher yield in idenification of temporal lobe epileptogenic zone thanfrontal lobe epileptogenic zone. And sEEG has high accuracy in locating the occipital lobeepileptogenic zone when it shows MRI-positive.Through the analysis and conclusion of this whole paper, we see : 1.Epilepsy surgery is theeffective means for curing intractable epilepsy, especially for inside temporal lobe withhippocampal sclerosis and one-side lesions of occipital lobe. For the extensive lesions on frontallobe, the effect of the epilepsy surgery is bad, then it is necessary to consider whether to take theoperation.2. It is possible that intracranial electrode may not be necessary for some temporal patients,because scalp electrode and sphenoid electrode can locate the seizure focus. In that case, theseizure focus can be excised for one-time.3. The effect of the epilepsy surgery on MRI-positive is better than MRI-negative. |
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