2021年 · 第101卷第41期

Focal epilepsy always shows some kind of periodic recurrence, but the specific pattern of this cycle is not clear. In order to study the characteristics of various aspects of the seizure cycle, the research team retrospectively analyzed the data of continuous intracranial electroencephalography (cEEG) monitoring and epilepsy diary of 222 patients with drug-refractory epilepsy implanted with reactive nerve stimulation devices from January 19, 2004 to May 18, 2018 in the Epilepsy Center of the University of California, San Francisco and other hospitals. Study methods included: (1) self-reported daily seizure numbers, (2) CEEG-based hourly EEG seizure numbers; (3) Detection of interseizure epileptiform electrical activity (IEA) in short (daily) and long (multi-day) cycles. Outcome evaluation measures were characteristic of IEA and seizure cycle: (1) incidence, defined as the percentage of patients with a specific type of seizure cycle; (2) intensity, defined as the degree of consistency of seizures at certain stages of a potential cycle, as measured by phase-locked values (PLV); (3) Epileptic chronotype, defined as a pattern of seizure time apparent at the group level.

Temporal lobe epilepsy (TLE) is a common type of epilepsy, and there is still a certain recurrence rate after operation. The study mainly evaluated the preoperative brain structural network and clinical characteristics of drug-refractory TLE patients to determine their correlation with postoperative epileptic relapse. The study included 51 patients with TLE (all with anterior temporal lobectomy) and 29 healthy controls from the Department of Neurology, British National Hospital, London, UK. Preoperative and postoperative structural MR and diffusion imaging of each patient can generate 2 networks: preoperative brain network and surgical preservation network. After normalizing these networks relative to healthy controls, the number of abnormal nodes before surgery and the number of abnormal nodes expected to be eliminated after surgery can be determined. The study incorporated these 2 abnormal node measures and 13 clinical data obtained from each patient into a machine learning framework to assess the probability of a patient's recurrent seizure after surgery.

In recent years, with the continuous development of arthroscopic instruments and techniques, microscopic ankle ligament repair has received extensive attention. The technique can be divided into arthroscopically assisted inferior extensor retinaculum (IER) enhancement and arthroscopic anterior talofibular ligament (ATFL) repair. Arthroscopic techniques were used to treat chronic ankle instability (CAI), and anatomical repair of ATFL was considered a critical step. However, the need for additional IER enhancement is currently controversial. Studies have reported good outcomes after arthroscopic ATFL repair combined with IER enhancement at the cost of significantly increased surgical time and difficulty. Furthermore, since the anatomical origin of IER is located 10 mm in front of the calcaneo-fibular ligament, IER enhancement is not strictly anatomical repair and may increase the risk of postoperative joint mobility limitation.