Objective To analyze the EEG characteristics and clinical significance of subclinical epilepsy from frontotemporal lobe.Methods A collection of patients with epilepsy who had subclinical seizures monitored by 24-hour video EEG from January 2020 to January 2021 in the Neurology Department of General Hospital of Tianjin Medical University General Hospital, and analyzed the duration of seizures and the number of seizures on the EEG.The characteristics and clinical significance of onset time (sleep period/waking period), interictal discharge, and number of leads involved in seizures.Results A total of 18 patients were enrolled, and 280 clinical seizures (11/18) and 34 clinical seizures (9/18) were captured. Among them, 2 patients had both subclinical seizures and clinical seizures. Frontal lobe origin, 235 subclinical seizures and 15 clinical seizures; temporal lobe origin, 26 subclinical seizures and 19 clinical seizures; frontotemporal lobe origin, subclinical seizures 19 times, no clinical seizures were captured. In the subclinical seizure group (11/18), there were 163 sleep episodes (58.2%) and 117 (41.8%) during waking phase; in the clinical seizure group (9/18), 16 episodes during sleep (47.1%) , 18 seizures (52.9%) in the awake period. Among the leads involved in seizures, <6 leads, 270 subclinical seizures, and no clinical seizures; ≥6 leads, subclinical seizures 10 times, and 34 clinical seizures. In the total duration of seizures: the clinical seizure group was (27.43±17.73) s, with a median value of 30s; the subclinical seizure group was (20.10±15.68) s, with a median value of 13 s. In the analysis of Spearman related factors, the subclinical seizure group was positively correlated with the sleep period (P=0.000), and negatively correlated with the normal nuclear magnetic field (P=0.004).Conclusion The epilepsy originated from the frontotemporal lobe has the characteristics of short clinical seizures, fewer leads involved, more likely to occur during sleep, and subclinical seizures that are more likely to occur when the MRI is abnormal. Therefore, strengthening the monitoring of long-term video EEG for patients with epilepsy and attaching importance to the interpretation of EEG during sleep will help to detect the subclinical seizures of patients and further improve the management of patients with epilepsy.
Objective To investigate clinical features and surgical outcome in children with frontal lobe epilepsy by evaluating the correlation between the predictive factors and seizure freedom. Methods 18 children who underwent frontal lobe epileptogenic resection in the Epilepsy Center of the Children's Hospital of Fudan University between January 2017 and December 2019 with a minimum follow up of 2 year were analyzed retrospectively. Each patient was evaluated with detailed data to predict postsurgical seizure freedom by analysis of variance. Results Of the 18 patients, there were 11 males and 7 females, the age at surgery ranged from 21 months to 11 years old (6.8±2.73) and the duration of seizures was from 1 month to 9 years. 17 patients had focal seizures, while 1 had generalized epileptic spasm. In scalp EEG, interictal and initial ictal discharges were frontal in 11 and 9 cases, respectively. MRI was indicative of FCD in 10 cases, tumor in 2, tuberous sclerosis and gliosis lesion in 1 case each. 4 patients were MRI negative. 11 patients underwent epileptogenic lesion resections directly and 7 cases received depth electrodes implantation and underwent stereo-electroencephalography to localize epileptogenic zone. At follow-up of 2 years, 14 (77.8%) patients remained seizure-free (Engel Ⅰ), 1 (5.6%) had marked seizure reduction (Engel Ⅱ), 2 (11.0%) showed minor improvement (Engel Ⅲ), and only 1 (5.6%) showed no response (Engel Ⅳ). About predictors of seizure recurrence, there were no significant differences in gender, age at surgery, age of seizure onset, duration of epilepsy, lateralization of epileptogenic zone, positive MRI findings, interictal and ictal discharge, etiology, intellectual development and stereo-electroencephalography implantation, while significantly higher rates of seizure freedom correlated with complete the resection of the epileptogenic zone. Conclusions Focal cortical dysplasia is the most common cause in childhood with frontal lobe epilepsy and complete resection of the epileptogenic zone can lead to good seizure control outcome.
ObjectiveTo explore the long-term seizure outcome and prognostic factors of patients with frontal lobe epilepsy after surgery, so as to guide the evaluation of treatment and provide clinical reference.Methods This study retrospectively analyzed the clinical data of patients with frontal lobe epilepsy undergoing surgical treatment by multimodal epilepsy surgical evaluation system in the functional neurosurgery of the Second Hospital of Lanzhou University from January 2016 to February 2020, there were 17 males and 13 females, the age of onset of epileptic seizures was (16.30±10.65) years, the age at the time of surgical treatment was (23.98±11.04) years, and the duration of seizures was (7.68±6.37) years. The multimodal epilepsy surgical evaluation system includes phase I non-invasive evaluation and phase II invasive evaluation. The collected research variables were analyzed by descriptive statistics and multivariate logistic regression analysis to evaluate the importance of each research variable to the prognosis of epilepsy surgery, and to determine the potential prognostic factors, so as to explore the epilepsy control situation of patients with frontal lobe epilepsy after surgery and the influence of each variable that may affect the prognosis of epilepsy on the prognosis.ResultsThe analysis of the clinical data of 30 patients with frontal lobe epilepsy showed that the good prognosis rate after FLE surgery (Engel I) was 70%, and the average follow-up was (29.9±14.1) months. The results of multivariate logistic regression analysis showed that the duration of epilepsy, the frequency of seizures, the presence or absence of stereotactic EEG (SEEG) monitoring, whether the lesion was completely removed, and whether acute postoperative seizures occurred were independent predictors of prognosis (P<0.05).ConclusionThis study found that the long duration of epilepsy, frequent seizures, and postoperative acute seizures are significantly related to poor prognosis. The application of SEEG and complete resection of epileptic lesions can significantly improve the prognosis of FLE surgery.
Objective To research clinical manifestations, electrophysiological characteristics of epileptic seizures arising from diagonal sulci (DS), to improve the level of the diagnosis and treatment of frontal epilepsy. MethodsWe reviewed all the patients underwent a detailed presurgical evaluation, including 5 patients with seizures to be proved originating from diagonal sulci by Stereo-electroencephalography (SEEG). All the 5 patients with detailed medical history, head Magnetic resonance (MRI), the Positron emission computered tomography (PET-CT) and psychological evaluation, habitual seizures were recorded by Video-electroencephalography (VEEG) and SEEG, we review the intermittent VEEG and ictal VEEG, analyzing the symptoms of seizures. Results 5 patients were divided into 2 groups by SEEG, group 1 including 3 patients with seizures arising from the bottom of DS, group 2 including 2 patients with seizures arising from the surface of DS, all the tow groups with seizures characterized by both having tonic and complex motors, tonic seizures were prominent in seizures from left DS, and tonic seizures may absent in seizures from right DS. Intermittent discharges with group1 were diffused, and intermittent discharges with group 2 were focal, but both brain areas of frontal and temporal were infected. Ictal EEG findings were consistent with the characteristics of neocortical seizures, the onset EEG shows voltage attenuation, seizures from bottom of DS with diffused EEG onset, and seizures from surface of DS with more focal EEG onset, but both frontal and anterior temporal regions were involved. Conclusionthe symptom of seizures arising from DS characterized by tonic and complex motor, can be divided into seizures arising from the bottom of DS and seizures from the surface of DS, with different electrophysiological characters.