动态脑电图评估在胶质瘤相关癫痫患者术后减停抗癫痫药物中的价值

梁新宜; 但炜; 姜代分; 练欢; 李欣; 谢延风; 石全红; 詹彦

doi:10.16016/j.2097-0927.202107129

您当前的位置：

首页 >

文章列表页 >

动态脑电图评估在胶质瘤相关癫痫患者术后减停抗癫痫药物中的价值

临床医学 | 更新时间：2026-01-09

- 动态脑电图评估在胶质瘤相关癫痫患者术后减停抗癫痫药物中的价值
- Value of ambulatory electroencephalogram in evaluation of postoperative withdrawal of antiepileptic drugs in patients with glioma-related epilepsy
- 陆军军医大学学报 2022年44卷第7期页码：718-723
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院神经外科
- 作者简介：
  
  [但炜，E-mail: 2843161092@qq.comDAN Wei, E-mail: 2843161092@qq.com
- 基金信息：
  
  国家临床重点专科建设项目((2011)170号);重庆市卫生局重点课题(2012-1-008)
- DOI：10.16016/j.2097-0927.202107129
  中图分类号： R730.264;R741.044;R742.1
- 收稿：2021-07-19，
  
  修回：2021-10-10，
  
  纸质出版：2022-04-15
- 稿件说明：
移动端阅览
梁新宜, 但炜, 姜代分, 等. 动态脑电图评估在胶质瘤相关癫痫患者术后减停抗癫痫药物中的价值[J]. 陆军军医大学学报, 2022,44(7):718-723.

Xinyi LIANG, Wei DAN, Daifen JIANG, et al. Value of ambulatory electroencephalogram in evaluation of postoperative withdrawal of antiepileptic drugs in patients with glioma-related epilepsy[J]. Journal of Army Medical University, 2022, 44(7): 718-723.
梁新宜, 但炜, 姜代分, 等. 动态脑电图评估在胶质瘤相关癫痫患者术后减停抗癫痫药物中的价值[J]. 陆军军医大学学报, 2022,44(7):718-723. DOI： 10.16016/j.2097-0927.202107129.

Xinyi LIANG, Wei DAN, Daifen JIANG, et al. Value of ambulatory electroencephalogram in evaluation of postoperative withdrawal of antiepileptic drugs in patients with glioma-related epilepsy[J]. Journal of Army Medical University, 2022, 44(7): 718-723. DOI： 10.16016/j.2097-0927.202107129.

摘要

目的

探讨术前有胶质瘤相关癫痫(glioma related epilepsy，GRE)病史的患者术后停药前动态脑电图(ambulatory electroencephalogram，AEEG)异常是否与癫痫复发相关。

方法

回顾性分析本院2014年1月至2020年6月68例行手术治疗且长期随访的GRE患者AEEG及临床资料

根据停用抗癫痫药后是否出现癫痫复发，将病例分为发作组(停药后癫痫复发)和对照组(停药后无癫痫发作)，分析两组棘尖波及阵发性慢波事件(paroxysmal slow wave events，PSWEs)出现率、数量差异。通过回顾性分析停药前AEEG显示有痫性放电的47例患者临床资料，探讨影响其癫痫预后的因素。

结果

① 发作组31例患者停药前AEEG中有痫性放电者29例(93.5%)，有PSWEs者11例(35.5%)，对照组37例患者停药前AEEG中有痫性放电者18例(48.6%)，有PSWEs者5例(13.5%)。发作组与对照组之间棘尖波及PSWEs出现率差异具有统计学意义(

＜0.05)。②发作组棘尖波及慢波数量明显高于对照组，发作组主要以中大量棘尖波(25/29，86.2%)及大量阵发性慢波(8/11

72.7%)为主，对照组主要以少量棘尖波(14/18

77.8%)及少中量阵发性慢波(4/5

80.0%)为主。③伴有AEEG痫性放电时，肿瘤切除程度及肿瘤累及皮层与癫痫预后有关(

＜0.05)。

结论

当肿瘤为次全切除或肿瘤累及皮质，同时停药前AEEG显示中量、大量棘尖波及PSWEs时，需考虑减缓停药，延长患者无发作间隔时间以降低癫痫复发风险。

Abstract

Objective

To explore whether the abnormality of ambulatory electroencephalogram (AEEG) prior to postoperative drug withdrawal is related to the recurrence of epilepsy after drug discontinuation in patients with glioma related epilepsy (GRE).

Methods

The clinical data and AEEG of 68 GRE patients who underwent surgical treatment in our hospital with long-term follow-up from January 2014 to June 2020 were collected and retrospectively analyzed. The patients were subsequently divided into seizure group (seizure recurrence after withdrawal of antiepileptic drugs

=31) and control group (no seizure after withdrawal

=37). The differences in the occurrence rate and number of spike waves and paroxysmal slow wave events (PSWEs) were analyzed and compared between the 2 groups. The factors affecting the prognosis of epilepsy were discussed through analyzing the data of 47 patients who presented epileptic discharge on AEEG before drug discontinuation.

Results

① In the seizure group

29 patients (93.5%) had epileptic discharges on AEEG before drug withdrawal

and 11 (35.5%) showed PSWEs

while there were only 18 (48.6%) and 5 (13.5%) patients correspondingly in the control group

indicating a significant difference in the occurrence rate between the 2 groups (

0.05). ② The number of spike and slow waves was significantly larger in the seizure group than the control group. In the seizure group

medium to large number of spike waves (25/29

86.2%) as well as large number of paroxysmal slow waves (8/11

72.7%) were predominant

whereas the control group mainly had small amount of spike waves (14/18

77.8%) and small to medium amount of paroxysmal slow waves (4/5

80.0%). ③ With epileptic discharge of AEEG

the extent of tumor removal and involvement of cortex were related to the epilepsy prognosis (

0.05).

Conclusion

When the tumor is sub-radical resected or the tumor involves the cortex

and the pre-discontinuation AEEG shows moderate to large number of epileptic discharge and PSWEs

it is necessary to consider suspending drug withdrawal and extending the interval between seizures to reduce the risk of seizure recurrence.

关键词

Keywords

references

YOU G, SHA Z Y, JIANG T. Clinical diagnosis and perioperative management of glioma-related epilepsy[J]. Front Oncol, 2020, 10: 550353. DOI: 10.3389/fonc.2020.550353.

王磊, 樊星, 梁树立. 《成人弥漫性胶质瘤相关癫痫临床诊疗指南》解读[J]. 中华神经外科杂志, 2019, 35(10): 976-980. DOI: 10.3760/cma.j.issn.1001-2346.2019.10.002.

WANG L, FAN X, LIANG S L. Interpretation of "Guidelines for Clinical Diagnosis and Treatment of Adult Diffuse Glioma-related Epilepsy"[J]. Chin J Neurosurg, 2019, 35(10): 976-980. DOI: 10.3760/cma.j.issn.1001-2346.2019.10.002.

SHAN X, FAN X, LIU X, et al . Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: a systematic review and meta-analysis[J ] . Neuro Oncol, 2018, 20(3): 324-331. DOI: 10.1093/neuonc/nox130.

NEAL A, MOROKOFF A, O'BRIEN T J, et al . Postoperative seizure control in patients with tumor-associated epilepsy[J ] . Epilepsia, 2016, 57(11): 1779-1788. DOI: 10.1111/epi.13562.

POLITSKY J M. Brain tumor-related epilepsy: a current review of the etiologic basis and diagnostic and treatment approaches[J]. Curr Neurol Neurosci Rep, 2017, 17(9): 70. DOI: 10.1007/s11910-017-0777-3.

LIANG S L, FAN X, ZHAO M, et al . Clinical practice guidelines for the diagnosis and treatment of adult diffuse glioma-related epilepsy[J ] . Cancer Med, 2019, 8(10): 4527-4535. DOI: 10.1002/cam4.2362.

LAMBERINK H J, OTTE W M, GEERTS A T, et al . Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis[J ] . Lancet Neurol, 2017, 16(7): 523-531. DOI: 10.1016/s1474-4422(17)30114-x.

KOEKKOEK J A, DIRVEN L, TAPHOORN M J. The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma[J]. Expert Rev Neurother, 2017, 17(2): 193-202. DOI: 10.1080/14737175.2016.1219250.

KERKHOF M, KOEKKOEK J A F, VOS M J, et al . Withdrawal of antiepileptic drugs in patients with low grade and anaplastic glioma after long-term seizure freedom: a prospective observational study[J ] . J Neurooncol, 2019, 142(3): 463-470. DOI: 10.1007/s11060-019-03117-y.

FRENCH J A. Withdrawal of antiepileptic drugs: an individualised approach[J]. Lancet Neurol, 2017, 16(7): 493-494. DOI: 10.1016/S1474-4422(17)30136-9.

VALIYAVEETTIL D, MALIK M, JOSEPH D M, et al . Effect of valproic acid on survival in glioblastoma: a prospective single-arm study[J ] . South Asian J Cancer, 2018, 7(3): 159-162. DOI: 10.4103/sajc.sajc_188_17.

方升, 但炜, 谢延风, 等. 双侧同步节律性慢波在幕上肿瘤患者继发癫痫中的易感性研究[J]. 第三军医大学学报, 2011, 33(20): 2191-2194. DOI: 10.16016/j.1000-5404.2011.20.022.

FANG S, DANW, XIE Y F, et al . Susceptibility of bilateral synchronous rhythmic slow wave in secondary epilepsy in patients with intracranial tumor[J ] . J Third Mil Med Univ, 2011, 33(20): 2191-2194. DOI: 10.16016/j.1000-5404.2011.20.022.

魏钰, 但炜, 陶园, 等. 动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究[J]. 第三军医大学学报, 2019, 41(5): 461-466. DOI: 10.16016/j.1000-5404.201810089.

WEI Y, DAN W, TAO Y, et al . Clinical study of ambulatory electroencephalography in reduction of prophylactic antiepileptic drugs after craniotomy[J ] . J Third Mil Med Univ, 2019, 41(5): 461-466. DOI: 10.16016/j.1000-5404.201810089.

LUNDSTROM B N, MEISEL C, VAN GOMPEL J, et al . Comparing spiking and slow wave activity from invasive electroencephalography in patients with and without seizures[J ] . Clin Neurophysiol, 2018, 129(5): 909-919. DOI: 10.1016/j.clinph.2018.02.006.

YAO J, WANG H, XIAO Z. Correlation between EEG during AED withdrawal and epilepsy recurrence: a meta-analysis[J]. Neurol Sci, 2019, 40(8): 1637-1644. DOI: 10.1007/s10072-019-03855-x.

LI Y, CHEN S, QIN J, et al . Risk of seizure recurrence from antiepileptic drug withdrawal among seizure-free patients for more than two years[J ] . Epilepsy Behav, 2020, 113: 107485. DOI: 10.1016/j.yebeh.2020.107485.

KAROLY P J, FREESTONE D R, BOSTON R, et al . Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity[J ] . Brain, 2016, 139(Pt 4): 1066-1078. DOI: 10.1093/brain/aww019.

FRAUSCHER B, VON ELLENRIEDER N, FERRARI-MARINHO T, et al . Facilitation of epileptic activity during sleep is mediated by high amplitude slow waves[J ] . Brain, 2015, 138(Pt 6): 1629-1641. DOI: 10.1093/brain/awv073.

MOXON K A, SHAHLAIE K, GIRGIS F, et al . From adagio to allegretto: The changing tempo of Theta frequencies in epilepsy and its relation to interneuron function[J ] . Neurobiol Dis, 2019, 129: 169-181. DOI: 10.1016/j.nbd.2019.02.009.

MILIKOVSKY D Z, OFER J, SENATOROV V V, et al . Paroxysmal slow cortical activity in Alzheimer's disease and epilepsy is associated with blood-brain barrier dysfunction[J ] . Sci Transl Med, 2019, 11(521): eaaw8954. DOI: 10.1126/scitranslmed.aaw8954.

WIRSCHING H G, WELLER M. Does neuronal activity promoteglioma progression?[J]. Trends Cancer, 2020, 6(1): 1-3. DOI: 10.1016/j.trecan.2019.11.002.

VENKATESH H S, MORISHITA W, GERAGHTY A C, et al. Electrical and synaptic integration of glioma into neural circuits[J]. Nature, 2019, 573(7775): 539-545. DOI: 10.1038/s41586-019-1563-y.

GILL B J A, WU X P, KHAN F A, et al . Ex vivo multi-electrode analysis reveals spatiotemporal dynamics of ictal behavior at the infiltrated margin of glioma[J ] . Neurobiol Dis, 2020, 134: 104676. DOI: 10.1016/j.nbd.2019.104676..

STILL M E H, ROUX A, HUBERFELD G, et al . Extent of resection and residual tumor thresholds for postoperative total seizure freedom in epileptic adult patients harboring a supratentorial diffuse low-grade glioma[J ] . Neurosurgery, 2019, 85(2): E332-E340. DOI: 10.1093/neuros/nyy481.

SHEN S, BAI Y, ZHANG B, et al . Correlation of preoperative seizures with a wide range of tumor molecular markers in gliomas: an analysis of 442 glioma patients from China[J ] . Epilepsy Res, 2020, 166: 106430. DOI: 10.1016/j.eplepsyres.2020.106430.

ARMSTRONG T S, GRANT R, GILBERT M R, et al . Epilepsy in glioma patients: mechanisms, management, and impact of anticonvulsant therapy[J ] . Neuro Oncol, 2016, 18(6): 779-789. DOI: 10.1093/neuonc/nov269.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

动态脑电图对开颅术后预防性抗癫痫药物减停的临床研究

癫痫儿童外周血p-糖蛋白水平在预测儿童抗癫痫药物疗效中的作用

联合瘤内及瘤周异质性的MRI影像组学预测高级别胶质瘤原位复发空间模式的价值

胶质瘤内肿瘤相关巨噬细胞的缺氧转录表型及细胞超微结构改变