难治性颞叶内侧癫痫术前评估方法再评价  

Retrospective analysis of presurgical evaluations for patients with intractable temporal lobe epilepsy

作　　者：张华[1] 梁秦川[1] 井晓荣[1] 王超[1] 郭恒[1] 游宇[1] 王海伟[1] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院神经外科,全军功能神经外科研究所,西安710038

出　　处：《立体定向和功能性神经外科杂志》2009年第1期15-17,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：国家自然科学基金项目(编号:30772221)

摘　　要：目的通过难治性颞叶内侧癫痫术后随访1年以上,术后效果达到Engel'sⅠ级(无发作)的患者,探讨各种术前评估方法确定癫痫灶的可靠程度。方法65名术后随访超过1年,术后达到Engel'sⅠ级疗效的难治性颞叶内侧癫痫患者,患者的发作症状学、神经影像和头皮脑电图进行回顾性分析。结果所有患者的发作间期正电子发射断层扫描(PET)显示与手术侧一致的颞叶低代谢改变;41例患者发作前存在典型的颞叶内侧常见先兆,所有患者发作起始表现为意识障碍;28例患者有手术侧颞叶影像异常(图1),8例患者存在双侧颞叶异常,8例患者存在多脑叶影像异常,21例患者核磁共振检查未发现明显异常;20%患者发作间期偶有异常、80%患者存在多灶棘波、尖波、棘慢波;发作期脑电放电早期显示:20例患者无法确定起源侧别,45例患者可以确定侧别(手术侧),只有21例患者可以清楚的显示手术侧蝶骨电极起源。结论患者的发作症状学分析和PET检查是难治性颞叶内侧癫痫术前评估中基本和重要的评估手段。Objective To retrospectively analyze presurgical evaluations for patients with intractable temporal lobe epilepsy （TLE） who had Engel＇s I outcomes for at least one year after standard anterior temporal lobe resection, and find out which one is the reliable presurgical evaluation for correct localization of epileptogenic zone. Methods There were 65 patients with intractable TLE who had Engel＇s I outcomes at least one year after standard anterior temporal lobe resection. The patients＇ seimiology, neuroimaging, and ictal electroencephalography （EEG） were retrospectively analyzed. No patient underwent intracranial EEG monitoring. Results All patients had asymmetric changes on positron emission tomography （PET） scans and the sides with lower FDG accumulation were consisted with surgical sides. For semiology, 41 patients had auras which are typically encountered in TLE and all patients had seizure type which is beginning with unconsciousness with or without auras. 28 patients had unilateral temporal lobe abnormalities, 8 cases with bilateral abnormalities, 8 cases with multiple lobe abnormalities and 21 cases with no abnormality on MRI scans. On ictal EEG, at the very beginning of EEG onset, there were 20 cases cannot be lateralized, 45 cases with lateralized onset sign but only 21 cases with unilateral sphenoidal electrode involved at the beginning with onset. Conclusion In this serial, PET scans with asymmetric changes and semiology are reliable predictors for good surgical outcomes.

关 键 词：难治性癫痫 颞叶内侧癫痫 正电子发射断层扫描 脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]