Application of stereoelectroencephalography in the refractory epilepsy related to periventricular nodular heterotopia_Journal of Epilepsy

Authors：

WANG Xiao ^1,2 , CHEN Junxi ¹ , WANG Shiyong ² , LI Wei ² , JIN Yang ³ ,  HU Xiangshu ³

1. Epilepsy center of Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China;
2. Epilepsy center of the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China;
3. Department of Neurosurgery, the Second People’s Hospital of Guangdong Province, Guangzhou, 510320, China;

Corresponding?author：

HU Xiangshu, Email: hxs75@126.com

Keywords：

Epilepsy; Stereoelectroencephalography; Periventricular nodular heterotopia; Epileptogenicity; Radiofrequency thermocoagulation

DOI：

10.7507/2096-0247.202305010

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Objective To investigate the application of stereoelectroencephalography (SEEG) in the refractory epilepsy related to periventricular nodular heterotopia (PNH). Methods Ten patients with drug-resistant epilepsy related to PNHs from Guangdong Sanjiu Brain Hospital and the First Affiliated Hospital of Jinan University from April 2017 to February 2021 were studied. Electrodes were implanted based on non-invasive preoperative evaluation. Then long-term monitoring of SEEG was carried out. The patterns of epileptogenic zone (EZ) were divided into four categories based on the ictal SEEG: A. only the nodules started; B. nodules and cortex synchronous initiation; C. the cortex initiation with early spreading to nodules; D. only cortex initiation. All patients underwent SEEG-guided radiofrequency thermocoagulation (RFTC), with a follow-up of at least 12 months. Results All cases were multiple nodules. Four cases were unilateral and six bilateral. Eight cases were distributed in posterior pattern, and one in anterior pattern and one in diffused pattern, respectively. Seven patients had only PNH (pure PNH) and three patients were associated with other overlying cortex malformations (PNH plus). The EZ patterns of all cases were confirmed by the ictal SEEG: six patients were in pure type A, two patients were in pure type B, one patient in type A+B and one in type A+B+C, respectively. In eight patients SEEG-guided RF-TC was targeted only to PNHs; and in two patients RFTC was directed to both heterotopias and related cortical regions. The mean follow up was (33.4±14.0) months (12 ~ 58 months). Eight patients (in pure type A or type A included) were seizure free. Two patients were effective. None of the patients had significant postoperative complications or sequelae. Conclusion The epileptic network of Epilepsy associated with nodular heterotopia may be individualized. Not all nodules are always epileptogenic, the role of each nodule in the epileptic network may be different. And multiple epileptic patterns may occur simultaneously in the same patient. SEEG can provide individualized diagnosis and treatment, be helpful to prognosis.

Citation： WANG Xiao, CHEN Junxi, WANG Shiyong, LI Wei, JIN Yang, HU Xiangshu. Application of stereoelectroencephalography in the refractory epilepsy related to periventricular nodular heterotopia. Journal of Epilepsy, 2023, 9(4): 271-280. doi: 10.7507/2096-0247.202305010 Copy

1.	Mirandola L, Mai RF, Francione S, et al. Stereo-EEG: diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies. Epilepsia, 2017, 58(11): 1962-1971.
2.	中國醫師協會神經外科分會功能神經外科學組, 中國抗癲癇協會, 國家神經外科手術機器人應用示范項目專家指導委員會. 立體定向腦電圖引導射頻熱凝毀損治療藥物難治性癲癇的中國專家共識. 中華醫學雜志, 2021, 101(29): 2276-2282.
3.	Khoo HM, Gotman J, Hall JA, et al. Treatment of epilepsy associated with periventricular nodular heterotopia. Curr Neurol Neurosci Rep, 2020, 20(12): 59.
4.	Cvetkovska E, Martins WA, Gonzalez-Martinez J, et al. Heterotopia or overlaying cortex: What about in-between? Epilepsy Behav Case Reports, 2019, 11: 4-9.
5.	Cossu M, Fuschillo D, Casaceli G, et al. Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases. J Neurosurg, 2015, 123（6）: 1358-1367.
6.	Cossu M, Mirandola L, Tassi L. RF-ablation in periventricular heterotopia-related epilepsy. Epilepsy Res, 2018, 142: 121-125.
7.	耿俊紅, 侯群, 蔣艷. 腦室旁結節狀灰質異位相關癲癇的研究進展. 中華神經醫學雜志, 2021, 20(9): 960-962.
8.	鄧馨, 王利霞, 王薇薇, 等. 灰質異位伴癲癇發作5例報告及文獻復習. 中風與神經疾病雜志, 2019, 36(8): 743-745.
9.	鄧馨, 王薇薇, 吳遜. 灰質異位與癲癇發作. 癲癇雜志, 2018, 4(6): 497-504.
10.	劉文鈺, 安東梅, 周東. 中國西部70例室管膜下型灰質異位癥伴癲癇患者的回顧性研究. 癲癇雜志, 2017, 3(6): 459-464.
11.	Liu W, Yue Q, Tian Y, et al. Neural functional connectivity in patients with periventricular nodular heterotopia-mediated epilepsy. Epilepsy Research, 2021, 170(1247): 106548.
12.	林紹鵬, 鄧宇虹, 劉曉蓉, 等. 雙側腦室旁結節狀灰質異位癥患者11例影像與臨床研究. 中華神經科雜志, 2008, 41(1): 29-32.
13.	劉暢, 王亮, 桑林, 等. 立體腦電圖引導射頻熱凝毀損治療腦室旁結節狀灰質異位相關癲癇. 中華神經外科雜志, 2018, 34(12): 1222-1226.
14.	華剛, 譚紅平, 姜楠, 等. SEEG引導下射頻熱凝毀損術在癲癇外科中的應用. 立體定向和功能性神經外科雜志, 2020, 33(2): 69-73.
15.	Alis C, Alis D, Uslu Besli L, et al. The analysis of 18 F-FDG PET/MRI, electroencephalography, and semiology in patients with gray matter heterotopia: a pilot study. Acta Neurol Scand, 2022, 146(5): 662-670.
16.	Barkovich AJ, Guerrini R, Kuzniecky RI, et al. A developmental and genetic classification for malformations of cortical development: update 2012. Brain A Journal of Neurology, 2012, 135(5): 1348-1369.
17.	Kahane P , Elisabeth Landré, Minotti L , et al. The Bancaud and Talairach view on the epileptogenic zone: A working hypothesis. Epileptic disorders: international epilepsy journal with videotape, 2006, 8 （suppl 2）: S16-26.
18.	Bourdillon P, Cucherat M, Isnard J, et al. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: a systematic review and meta-analysis. Epilepsia, 2018, 59（12）: 2296-2304.
19.	Battaglia G, Chiapparini L, Franceschetti S, et al. Periventricular nodular heterotopia: classification, epileptic history, and genesis of epileptic discharges. Epilepsia, 2010, 47(1): 86-97.
20.	Li LM, Dubeau F, Andermann F, et al. Periventricular nodular heterotopia and intractable temporal lobe epilepsy: poor outcome after temporal lobe resection. Ann Neurol, 1997, 41(5): 662-668.
21.	Khoo HM, von Ellenrieder N, Zazubovits N, et al. Internodular functional connectivity in heterotopia-related epilepsy. Ann Clin Transl Neurol, 2019, 6(6): 1010-1023.
22.	Aghakhani Y, Kinay D, Gotman J, et al. The role of periventricular nodular heterotopia in epileptogenesis. Brain, 2005, 128(3): 641-651.
23.	Tassi L, Colombo N, Cossu M, et al. Electroclinical, MRI and neuropathological study of 10 patients with nodular heterotopia, with surgical outcomes. Brain, 2005, 128(2): 321-337.
24.	Thompson SA, Kalamangalam GP, Tandon N. Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure, 2016, 41: 211-216.

1. Mirandola L, Mai RF, Francione S, et al. Stereo-EEG: diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies. Epilepsia, 2017, 58(11): 1962-1971.
2. 中國醫師協會神經外科分會功能神經外科學組, 中國抗癲癇協會, 國家神經外科手術機器人應用示范項目專家指導委員會. 立體定向腦電圖引導射頻熱凝毀損治療藥物難治性癲癇的中國專家共識. 中華醫學雜志, 2021, 101(29): 2276-2282.
3. Khoo HM, Gotman J, Hall JA, et al. Treatment of epilepsy associated with periventricular nodular heterotopia. Curr Neurol Neurosci Rep, 2020, 20(12): 59.
4. Cvetkovska E, Martins WA, Gonzalez-Martinez J, et al. Heterotopia or overlaying cortex: What about in-between? Epilepsy Behav Case Reports, 2019, 11: 4-9.
5. Cossu M, Fuschillo D, Casaceli G, et al. Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases. J Neurosurg, 2015, 123（6）: 1358-1367.
6. Cossu M, Mirandola L, Tassi L. RF-ablation in periventricular heterotopia-related epilepsy. Epilepsy Res, 2018, 142: 121-125.
7. 耿俊紅, 侯群, 蔣艷. 腦室旁結節狀灰質異位相關癲癇的研究進展. 中華神經醫學雜志, 2021, 20(9): 960-962.
8. 鄧馨, 王利霞, 王薇薇, 等. 灰質異位伴癲癇發作5例報告及文獻復習. 中風與神經疾病雜志, 2019, 36(8): 743-745.
9. 鄧馨, 王薇薇, 吳遜. 灰質異位與癲癇發作. 癲癇雜志, 2018, 4(6): 497-504.
10. 劉文鈺, 安東梅, 周東. 中國西部70例室管膜下型灰質異位癥伴癲癇患者的回顧性研究. 癲癇雜志, 2017, 3(6): 459-464.
11. Liu W, Yue Q, Tian Y, et al. Neural functional connectivity in patients with periventricular nodular heterotopia-mediated epilepsy. Epilepsy Research, 2021, 170(1247): 106548.
12. 林紹鵬, 鄧宇虹, 劉曉蓉, 等. 雙側腦室旁結節狀灰質異位癥患者11例影像與臨床研究. 中華神經科雜志, 2008, 41(1): 29-32.
13. 劉暢, 王亮, 桑林, 等. 立體腦電圖引導射頻熱凝毀損治療腦室旁結節狀灰質異位相關癲癇. 中華神經外科雜志, 2018, 34(12): 1222-1226.
14. 華剛, 譚紅平, 姜楠, 等. SEEG引導下射頻熱凝毀損術在癲癇外科中的應用. 立體定向和功能性神經外科雜志, 2020, 33(2): 69-73.
15. Alis C, Alis D, Uslu Besli L, et al. The analysis of 18 F-FDG PET/MRI, electroencephalography, and semiology in patients with gray matter heterotopia: a pilot study. Acta Neurol Scand, 2022, 146(5): 662-670.
16. Barkovich AJ, Guerrini R, Kuzniecky RI, et al. A developmental and genetic classification for malformations of cortical development: update 2012. Brain A Journal of Neurology, 2012, 135(5): 1348-1369.
17. Kahane P , Elisabeth Landré, Minotti L , et al. The Bancaud and Talairach view on the epileptogenic zone: A working hypothesis. Epileptic disorders: international epilepsy journal with videotape, 2006, 8 （suppl 2）: S16-26.
18. Bourdillon P, Cucherat M, Isnard J, et al. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: a systematic review and meta-analysis. Epilepsia, 2018, 59（12）: 2296-2304.
19. Battaglia G, Chiapparini L, Franceschetti S, et al. Periventricular nodular heterotopia: classification, epileptic history, and genesis of epileptic discharges. Epilepsia, 2010, 47(1): 86-97.
20. Li LM, Dubeau F, Andermann F, et al. Periventricular nodular heterotopia and intractable temporal lobe epilepsy: poor outcome after temporal lobe resection. Ann Neurol, 1997, 41(5): 662-668.
21. Khoo HM, von Ellenrieder N, Zazubovits N, et al. Internodular functional connectivity in heterotopia-related epilepsy. Ann Clin Transl Neurol, 2019, 6(6): 1010-1023.
22. Aghakhani Y, Kinay D, Gotman J, et al. The role of periventricular nodular heterotopia in epileptogenesis. Brain, 2005, 128(3): 641-651.
23. Tassi L, Colombo N, Cossu M, et al. Electroclinical, MRI and neuropathological study of 10 patients with nodular heterotopia, with surgical outcomes. Brain, 2005, 128(2): 321-337.
24. Thompson SA, Kalamangalam GP, Tandon N. Intracranial evaluation and laser ablation for epilepsy with periventricular nodular heterotopia. Seizure, 2016, 41: 211-216.

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Application of stereoelectroencephalography in the refractory epilepsy related to periventricular nodular heterotopia

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