婴幼儿全身强直-阵挛癫痫发作间期SPECT与长程EEG的对比研究  

Comparative study of interictal SPECT and long-term EEG for generalized tonic-clonic seizure epilepsies in infants

作　　者：赵斯钰[1] 王为民[1] 

机构地区：[1]兰州大学第二医院癫痫中心甘肃省癫痫防治中心,兰州730000

出　　处：《山西医科大学学报》2011年第2期145-148,共4页Journal of Shanxi Medical University

基　　金：甘肃省科研攻关课题(432328)

摘　　要：目的通过对全身强直-阵挛性癫痫婴幼儿发作间期单光子发射计算机断层成像术(single-photon emission computedtomography,SPECT)与长程脑电图的对比研究,评价SPECT与EEG在癫痫灶定位诊断的价值。方法对100例3岁内全身强直-阵挛癫痫患儿进行癫痫发作类型的确诊和神经系统检查、发作间期SPECT显像、长程EEG与影像学检查。结果发作间期SPECT异常76例(76%),高灌注43例(56.6%)、低灌注30例(39.5%)、高-低灌注3例(3.9%);异常灌注灶125个:颞叶51个(40.8%)、额叶18个、顶叶21个、枕叶8个、底节区16个、丘脑2个、小脑9个。长程监测脑电图异常84例(84%),痫样放电76例(90.5%),弥漫性异常62例(82.8%)和局灶性异常22例(26.2%)。CT/MRI异常27例(27%)。SPECT异常灌注灶与EEG的致痫灶相符者13例(19.7%),相近者30例(45.5%),不相符者23例(34.8%)。结论婴幼儿全身强直-阵挛性癫痫发作间期SPECT显像的特点以高灌注灶为主,颞叶异常灌注灶数明显高于其他各叶。长程EEG表现痫样放电以广泛性多见。SPECT的异常灌注灶与EEG的致痫灶的相关性较低。临床上应当结合SPECT、长程脑电图等检查结果进行综合分析,以提高致痫灶定位的准确性。Objective To evaluate the value of single-photon emission computed tomography（SPECT）and long-term EEG in localization of generalized tonic-clonic seizure epilepsies.Methods One hundred infant patients with generalized tonic-clonic seizure epilepsies were examined by interictal SPECT,long-term EEG and CT/MRI.Results Interictal SPECT was abnormal in 76 patients（76%）,including hyperperfusion in 43 patients（56.6%）,hypoperfusion in 30 patients（39.5%）and hyper-hypoperfusion in 3 patients（3.9%）.A total of 125 focus were abnormal perfusion,including 51 on temporal lobe,18 on frontal lobe,21 on parietal lobe and 8 on occipital lobe.Additionally,16 abnormal focus were distributed on basal ganglia,2 on thalamus and 9 on cerebellum.Long-term EEG was abnormal in 84 patients（84%）,including focal discharge in 22 cases and widespread in 62 cases.Of 84 patients,76（90.5%）had epileptiform discharge.CT/MRI abnormality was found in 27 patients（27%）.The SPECT abnormal focus and EEG epileptiform discharge zones were found accordant in 13 cases（19.7%）,similar in 30 cases（45.5%）and unrelated in 23 cases（34.8%）.Conclusion The interictal SPECT of infant patients with generalized tonic-clonic seizure epilepsies mostly show hyperperfusion,and the focuses on temporal lobe are more than that on any other lobes.Generalized epileptic discharge is the main manifestation of long-term EEG.There is a rather low correlation between abnormal focus of SPECT and epileptogenic zones of EEG in the infants with generalized tonic-clonic seizure epilepsies.In clinical application,SPECT and long-term EEG should be combined to use for improving the accuracy of localization of the epileptogenic focus.

关 键 词：婴幼儿 全身强直-阵挛性发作 发作间期SPECT 长程脑电图 高灌注 颞叶 痫样放电 

分 类 号：R748[医药卫生—神经病学与精神病学]