The Relationship Between Seizure-onset Patterns Of Scalp-eeg And Epileptogenic Lesions In Intractable Temporal Lobe Epilepsy

Objective:To investigate the relationship between the seizure-onset patterns of scalp-EEG and epileptogenic lesions in intractable temporal lobe epilepsy(ITLE).Methods: The clinical information of 45 patients with ITLE and their172 times video EEG(V-EEG)data were analyzed retrospectively from September 2011 to September 2015 in our hospital.All cases underwent resectional epilepsy treatment,followed up for at least 1 year,the postoperative evaluation was Engel Grade I.According to the preoperative magnetic resonance imaging(MRI)showed epileptogenic lesions were divided into the mesial temporal lobe epilepsy(MTLE)and neocortical temporal lobe epilepsy(NTLE);After surgery,there were 6 different pathological types.The seizure-onset patterns were analyzed,and compare their quantity difference in different parts and different pathological types,and explore the different patterns' localizing value and possible neurophysiological mechanism.Results:(1)The frequency of clinical onset with obviously seizure-onset pattern in 45 patients were 157 times,including 57 times(36.3%)of low-voltage fast activity(LVFA),35 times(22.3%)of ? rhythm,31 times(19.7%)of ? activity,20 times(12.7%)of sharp wave activity and14 times(8.9%)of low or middle amplitude polyspikes.The correctly localized pattern wers 103 times(65.6%),including 49 times(47.6%)of LVFA,and its localizing rate was significantly higher than other patterns(49/57 vs 54/100,P<0.01).(2)The 5 kinds of seizure-onset patterns all can be seen in MTLE and NTLE,LVFA's incidence in NTLE was significantly higher than in MTLE(46/89 vs 11/68,P<0.01),the incidence of slow activity(? rhythm and ? activity)in MTLE was higher than in NTLE(43/68 vs 23/89,P<0.05).About the sharpwave activity and low or middle amplitude polyspikes,there were no statistical difference in different parts(P>0.05).(3)The 5 kinds of seizure-onset patterns can be seen in different pathological types' epileptogenic lesions,the incidence of ? rhythm in hippocampal sclerosis(HS)was higher than other lesions(16/45 vs 19/112,P<0.05).Conclusion: ITLE's ictal scalp-EEG have a variety kinds of seizure-onset patterns,LVFA is mainly focal origin and has a better localizing value,and the ? rhythm may has a prompt value for HS.