局灶性皮质发育不良的脑电图特点与病理组织学改变相关性  

A study on the correlation between electroencephalography characteristic and histopathological change in epilepsy patients due to 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,北京100053 [2]首都医科大学宣武医院病理科,北京100053

出　　处：《中华神经科杂志》2009年第2期110-114,共5页Chinese Journal of Neurology

基　　金：基金项目：北京市科技新星计划资助项目（2006863）

摘　　要：目的研究局灶性皮质发育不良（FCD）皮质脑电图中发作期异常放电（ID）起源皮质与发作间期异常放电（IED）皮质之间病理学改变的特点及相互关系，进而探讨FCD的致痈机制。方法自2005年4月至2006年8月，以北京功能神经外科研究所收治的22例术前采用长程颅内电极埋置，术后病理证实为FCD的患者为研究对象。术中根据长程脑电图监测结果，对22例患者皮质上IED集中处与ID处分别给予切除。对2组病理标本进行多项病理组织学及免疫组织化学检查。结果共收集到20例患者的病理标本。ID与IED的病理组织学改变包括皮质结构紊乱、异常神经细胞及气球细胞的出现，皮质ID处的异常重于IED处。应用微小清蛋白（PV）半定量评分标准比较，FCDII型中IED[（4．4±1．8）分]与ID[（6．4±2．1）分]组间评分差异有统计学意义（P=0．042）。ID各分型之间组织标本的PV评分差异无统计学意义（F=2．734，P=0．093）。结论ID区域的病理组织学结构相对于IED紊乱，而且其抑制性神经元环路缺失的特点更为显著，提示ID区域的致痫性强于IED区域。各种ID波形均提示致痫灶，手术中应给予彻底切除。Objective To study the histopathologieal characteristics and the correlations between the cortical tissues from ictal discharge （IO） area and interictal epileptifonn discharge （IED） area in epilepsy patients due to focal cortical dysplasia （FCD）, in order to further discuss the mechanism of epileptogenicity. Methods Twenty-two subjects who underwent epilepsy surgeries consecutively in our institute since April 2005 to August 2006. All patients underwent intraeranial electrode implantations and long-term video-EEG monitoring before the resective surgeries and the postoperative pathologies proved to be FCD. According the long-term EEG monitoring results, the cortex with intense IED and the cortex with ID onset were resected separatively in the operation for further histopathologic studies. Twenty cases were collected. Based on the Palimini＇ s pathologic subtype classification for FCD as well as quantificational scoring for immunocytochemistry for the calcium-binding protein parvalbumin （PV） which we designed by ourself, the specimens of IED and ID were studied and compared. Results The resected specimens from 20 cases were examed. ID specimens showed more severe abnormalities in the laminar cortical architecture, alterations in the morphology of neurons and in the appearance of abnormal balloon cells. With the PV quantificational scoring, we found significant difference between IED （6.4 ±2. 1 ） and ID （4. 4 ± 1.8） from FCD Ⅱ specimens （P =0. 042）. No difference was found between ID subtypes （F = 2. 734, P = 0. 093）. Conclusions ID cortical area showed more severe abnormalities in histopathologic changes than IED area. Our results suggested that the ID area of FCD had more severe damage in inhibitory synaptic circuits and neural networks, which meant it was more epileptogenic than IED. No difference was identified between each ID subtype in term of epileptogenicity, which meant all of them should be resected during the surgery.

关 键 词：皮质发育畸形 脑电描记术 癫痫 

分 类 号：R686[医药卫生—骨科学]