Abstract
BackgroundNowadays, few surgery analysis has been reported in cases of epilepsy after viral encephalitis(VE). Herein, this study was to evaluate the efficacy of surgery and capability of stereoelectroencephalography (SEEG) in the definition of the epileptogenic zone (EZ) after VE, and also to explore the relationship between the SEEG features and the surgical outcomes.MethodsWe retrospectively analyzed 10 surgically treated patients that identified to suffer from epilepsy secondary to VE using SEEG, and investigated the SEEG features associated with surgical outcomes in these patients. Besides visual analysis, we used the epileptogenicity index (EI), a semi-quantitative and supplementary tool to evaluate the validity of SEEG in the context of VE.ResultsAmong the 10 operated patients, 3 of them became completely seizure-free. The patients who got totally seizure free or significant improvement, the seizure onset was located either in the antero-mesial temporal structures or focal gyrus; patients who got worthwhile improvement or no improvement, the seizure started from multiple brain lobes. The number of electrodes classified as epileptogenic visually involved were closely correlated with EI positive onses.Anatomic areas defined and shown as EZ on MRI by visual assessment were also defined as epileptogenic by the EI in these cases.ConclusionApart from exploring the surgical outcome related to epilepsy after VE, we also bring insight into the relationship between the SEEG features and surgical outcome with the application of the supplementary methods.
Highlights
Nowadays, few surgery analysis has been reported in cases of epilepsy after viral encephalitis(VE)
Patients and methods A total of 150 patients underwent epilepsy surgery using SEEG between January 2014 and March 2017 at the Epilepsy Center of Yuquan Hospital Tsinghua University in Beijing, among which we retrospectively enrolled 10 patients who suffered from epilepsy secondary to Viral encephalitis (VE). encephalitis defined by presentation with altered mental Status lasting more than 24 h, with at least three of the following manifestations:(1) temperature ≥ 38 °C within 72 h,(2) new-onset generalized or focal seizures, (3) new-onset focal neurologic deficits, (4) cerebrospinal fluid (CSF) white blood count (WBC) count ≥5/ mm3, (5) abnormality on neuroimaging consistent with encephalitis, (6) abnormality on electroencephalography (EEG) [11]
SEEG exploration is mandatory in the absence of a clear epileptogenic zone (EZ) or with diffuse lesion, especially for exploring deep seated structures.Even though we found that some patients had confined interictal discharges of scalp EEG, we still had to define the extension of EZ and its relationships with functional areas using SEEG
Summary
Few surgery analysis has been reported in cases of epilepsy after viral encephalitis(VE). This study was to evaluate the efficacy of surgery and capability of stereoelectroencephalography (SEEG) in the definition of the epileptogenic zone (EZ) after VE, and to explore the relationship between the SEEG features and the surgical outcomes. Few human data are available with the application of the intracerebral EEG recordings within suspected epileptogenic zone after VE, and there were rare studies on the characteristics of SEEG after VE and its correlation with surgical efficacy. In this present study, we reviewed SEEG data in a group of patients with epilepsy after VE, and the objective of which was to evaluate the applicability of SEEG in determining the EZ after VE. Our objectives were to assess the electro-clinical phenotype and the underlying epileptogenic zone defined by SEEG recordings, to reveal the relationship between the SEEG features and the surgical outcomes
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