局灶性皮质发育不良癫痫患者发作间期皮质脑电图特点及其病理学改变  

Correlation between characteristics of interictal epilepfform discharge and histopathological change in epilepsy patients with focal cortical dysplasia

作　　者：蔡立新[1] 朴月善[2] 刘磊[2] 卢德宏[2] 李勇杰[1] 

机构地区：[1]首都医科大学宣武医院北京功能神经外科研究所,100053 [2]首都医科大学宣武医院病理科,100053

出　　处：《中华医学杂志》2008年第17期1153-1157,共5页National Medical Journal of China

基　　金：北京市科技新星计划基金资助项目（2006863）

摘　　要：目的通过分析局灶性皮质发育不良（FCD）癫痫皮质脑电图发作间期异常放电（1ED）的表现特点与其病理学改变之间的相互关系，探讨应用IED判断致痫灶的可能性。方法以22例术前采用长程颅内电极埋置，术后病理学证实为FCD的患者为研究对象，根据长程颅内皮质脑电图监测结果，将患者的皮质IED分为4类：棘波、重复性棘慢波、多棘波以及低波幅快节律。手术中将IED集中且可能为致痫灶的皮质部位切除后，除常规病理学分析外，根据微小清蛋白（PV）免疫组化染色评价标准进行半定量分析对比。结果共收集到完整的病理标本20例。经统计各IED分型之间组织标本的PV评分差异无统计学意义（F=1．198，P〉0．05），但在数值上，棘波的PV平均分数最高，为8．00；多棘波的最低，为5．60。FCDI型中，棘波占58％，明显多于其他3类IED，而3例FCDIIB患者的IED皆为低波幅快节律。结论虽然应用PV半定量评分标准分析各种IED类型间的致痫性差异不大，但棘波的PV值最高，而且重复性棘慢波、多棘慢波与低波幅快节律在FCD病理严重程度级别高的患者中更易出现，提示它们的致痫性有高于棘波的趋势。Objective To discuss the correlation between characteristics of interietal epilepiform diseharge（IED） and histopathologieal changes in epilepsy patients with focal cortical dysplasia（FCD） in order to explore the epileptogenieity of various IED. Methods Twenty-two consecutive patients suspected as with FCD who were to undergo epilepsy surgery received intraeranial electrode implantation and long-term video-EEG monitoring before the reseetive surgery and the postoperative pathology proved the diagnosis of FCD. According the long-term EEG monitoring results, the IEDs were divided into four catalogs： isolated spike, slow repetitive spike, repetitive spike, and paroxysmal fast. The possible epileptogenie cortex with intense IED was reseeted in the operation to undergo histopathologie study and hemi-quantifieational scoring of parvalbumin （PV） by immunoeytoehemistry. Results The reseeted specimens of 20 eases were studied. There were not significant differences in the PV quantifieational score between any 2 IED subtypes （ F = 1. 198, P =0. 342）. However, the spike type had the highest PV score： 8.00, while the repetitive spike type had the lowest PV score： 5.60. On the other hand, FCD of different severity in terms of pathological changes tended to have different kind of IED. Conclusion Despite the insignificant differences between various kinds of IED, isolated spike has the highest PV scores meaning lower epileptogenieity. Slow repetitive spike, repetitive spike, and paroxysmal fast tend to occur in more severe FCD patients which mean a great possibility of epileptogenieity.

关 键 词：癫痫 大脑皮质 发育障碍 病理学 脑电描记术 

分 类 号：R686[医药卫生—骨科学]