해면상 혈관종에서의 간질병소에 대한 뇌파, 임상적, 병리적 관계

Abstract

Background and Purpose: Cavernous angiomas are frequently encountered in patients with intractable partial epilepsies. Cavernous angioma can make highly epileptogenic foci and dual pathology. Although it is generally thought that the epileptogenic activity originated in neuronal populations adjacent to the lesion, little is known as to the exact location of the epilepsies on electophysiologic, clinical and pathologic view. We investigated nine intractable epilepsy patients with cavernous angioma regarding relation of EEG, semiology and pathology to verify where are the epileptogenic foci in cavernous angioma. Methods: We included 9 intractable epilepsy patients with cavernous angioma who had been were undergone video-EEG monitoring. They were aged from 15 to 49 years(average:36.7+15.7)and had cavernous angioma in temporal, frontal lobe, or multiple areas(temporal:7, frontal:1, multiple:1 patients). Four patients had invasive EEG study including subdural and/or depth electrodes. Six patients had undergone epilepsy surgery. We analyzed seizure history, semiology of their seizures, interictal and ictal EEG. To know dual pathology, MRI including hippocampal volumetry, invasive EEG, and pathology were studied. Results: Four patients had multiple auras. Eight patients had complex partial seizures and one had right foot clonic seizure, which were related with the location of cavernous angioma. In scalp EEG, ictal recording showed definite EEG changes, but 3 patients had no definite EEG change in some seizures. In invasive EEG with subdural and/or depth electrodes , interictal spikes were more frequently detected than scalp EEG and ictal EEG revealed not only 3 different ictal onset zones in 3 patients but also EEG seizures without clinical events in 3 patients. Regarding dual pathology, mesial temporal involvement was detected in 2 patients in MRI. Among 6 surgery patients 4 patients including 3 patients with normal hippocampus in MRI had hippocampal or dentate gyral change in pathology. Among 4 patients with invasive ictal EEG, 3 patients including 1 patient with normal hippocampus in MRI and pathology had mesial temporal involvement in ictal onset zones. Conclusion: Cavernous angiomas can make multiple epileptogenic foci around themselves and often dual pathology of hippocampus, which can be easily detected by invasive ictal EEG but not by imaging and even by pathology. And the foci can have frequent EEG seizures, which do not make clinical events. Precise localization of epileptogenic foci in cavernous angioma were needed to have good medical and surgical treatments.