OBJECTIVE Postencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG). METHODS We conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex. RESULTS Independent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a "patchwork" organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048). CONCLUSIONS Postencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group. SIGNIFICANCE These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections.

中文翻译：

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Perisylvian易患脑炎后癫痫


目的 脑炎后癫痫通常对抗癫痫药物有抵抗力，因此需要评估癫痫手术。表征其定位对最佳手术方法具有重要意义。我们的目的是确定接受立体定向脑电图（SEEG）的耐药性癫痫患者的既往脑炎病史是否与特定的致癫痫网络相关。方法 我们对有或没有脑炎病史的耐药性癫痫进行了回顾性队列研究。我们分析了 SEEG 记录，以确定癫痫发作和组织的模式。从接受 SEEG 的患者数据库中识别出 17 名有脑炎病史（两名受试者具有感染性病因）的患者，并将其与 17 名无脑炎病史的耐药癫痫对照患者进行比较，以匹配混杂变量，包括植入前假设、癫痫持续时间、年龄和性别。结果 65% 的脑炎后癫痫队列中出现独立双侧癫痫发作。我们在有脑炎病史的患者中确定了四种 SEEG 发作模式：(1) 前内侧颞部发病 (24%)，(2) 前内侧颞部发病，早期扩散到侧裂区 (29%)，(3) 侧裂周围 (29%)。 59%）和（4）同步前内侧颞叶和侧裂周围（29%）发病。模式 3 和 4 发病时累及侧裂周围，是脑炎组所特有的（分别为 p = 0.0003 和 0.04），并表现出“拼凑”组织。与 5/7 的匹配对照相比，脑炎患者均未达到 Engel I 结果（p = 0.0048）。结论 脑炎后癫痫涉及颞前内侧和侧裂网络，通常以双侧独立的方式发生。 在脑炎组中发现了涉及侧裂周围区域的独特发作模式，但在匹配的对照组中则没有。意义 这些发现可能反映了侧裂周围区域对脑炎引起的癫痫的选择性脆弱性，从而显着降低了 SEEG 引导的颞叶切除术的成功机会。