高频振荡对局灶性皮质发育不良Ⅱ型所致癫痫中的定位诊断价值  

Diagnostic value of high frequency oscillation in localization of type Ⅱ focal cortical dysplasia epilepsy

作　　者：梅珍 林元相[1] 姚培森 王丰 黄小芬[1] 林涵[4] 胡雪群 林云清 高琳[4] 康德智[4] Mei Zhen;Lin Yuanxiang;Yao Peisen;Wang Feng;Huang Xiaofen;Lin Han;Hu Xuequn;Lin Yunqing;Gao Lin;Kang Dezhi(Department of Neurosurgery,First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China;Fujian Institute of Brain Disorders and Brain Science,Fuzhou 350005,China;Fujian Clinical Research Center for Neurological Diseases,Fuzhou 350005,China;Department of Neurosurgery,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005 [2]福建省脑重大疾病与脑科学研究院,福州350005 [3]福建省神经系统疾病临床医学研究中心,福州350005 [4]福建医科大学附属第一医院滨海院区国家区域医疗中心神经外科,福州350005

出　　处：《中华医学杂志》2024年第8期614-617,共4页National Medical Journal of China

基　　金：福建省教育厅中青年教师教育科研项目(JAT190201)

摘　　要：回顾性分析2020年11月至2023年2月于福建医科大学附属第一医院神经外科行立体脑电图(SEEG)植入的9例局灶性皮质发育不良(FCD)Ⅱ型所致癫痫患者,分析高频振荡(HFO)出现的部位、时间、频率,比较HFO与发作间期、发作前、发作期波形相关性。9例患者SEEG发作间期、发作期均记录到80~500 Hz HFO,其中6例患者记录到250~500 Hz快速涟波(FR)。手术切除发作起始区和FR发放电极,术后随访2年以上,5例为EngelⅠ。发作前6例患者SEEG呈持续性放电。持续性放电分布指数与发作频率呈正相关。发作期四型发作起始模式均出现80~500 Hz HFO。6例发作前为持续性放电并重叠HFO患者,手术切除发作起始区和FR发放电极,5例EngelⅠ。FCDⅡ型放电波形复杂、放电指数高,和HFO关系密切。与棘波相比HFO出现电极范围更为局限,发作前HFO发生率显著增高,与发作起始区相关性强,HFO与棘波同时出现比单独出现定位诊断价值更高,能有效提高手术疗效。Retrospective analysis was conducted on 9 patients with typeⅡfocal cortical dysplasia(FCD)who underwent stereo-electroencephalography(SEEG)implantation in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from November 2020 to February 2023.The onset area,onset time,and frequency of high-frequency oscillations(HFO)were analyzed and the correlation of HFOs with interictal,preictal,and ictal periods.SEEG recordings of 80-500 Hz HFOs were observed in both interictal and ictal periods in 9 patients,with 6 patients exhibiting fast ripples(FR)in the range of 250-500 Hz.Surgical resection of the seizure onset area and FR-generating electrodes was performed,and postoperative follow-up for over 2 years indicated Engel I in 5 cases.6 patients showed continuous discharge during the preictal period,and the distribution index of continuous discharge was positively correlated with seizure frequency.HFOs in the range of 80-500 Hz were present in all four seizure onset patterns during the ictal period.The onset area and FR-emitting electrode were surgically removed in 6 patients with continuous discharge and overlapping HFOs during the preictal period,with 5 cases of Engel I.TypeⅡFCD discharges exhibited complexity,high discharge indices,and a close association with HFOs.Compared with the spike wave,the electrode range of HF is more limited,and the incidence of HF before attack is significantly increased,which is closely correlated with the onset area.The simultaneous occurrence of HFO and the spike waves has higher diagnostic value than the individual occurrence,effectively enhancing surgical efficacy.

关 键 词：癫痫 局灶性皮质发育不良 脑电图 高频振荡 

分 类 号：R742.1[医药卫生—神经病学与精神病学]