脑磁图和视频脑电图在癫痫诊治中的应用(附337例报告)  

Application of MEG and V-EEG to diagnosis and therapy of epilepsy (a report of 337 cases)

作　　者：张弦[1] 杜寒剑[1] 李明荣[1] 邵卫国[1] 陈蕾[1] 吴国材[1] 

机构地区：[1]第三军医大学西南医院神经外科全军神经系统疾病微创专科诊治中心,重庆400038

出　　处：《中国临床神经外科杂志》2011年第3期135-137,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脑磁图(MEG)和视频脑电图(V-EEG)在癫痫诊治中的应用价值。方法本组应用MEG结合MRI、V-EEG对337例癫痫(其中174例为原发性癫痫,163例为继发性癫痫)患者行诊断及致痫灶定位检查;对本组251例(其中129例为原发性癫痫,122例为继发性癫痫)患者仅行抗癫痫药物治疗,86例(其中45例为原发性癫痫,41例为继发性癫痫)患者行手术治疗,治疗后6个月和1年均行MEG、V-EEG随访。结果 MEG检出癫痫患者319例,阳性检出率94.66%;V-EEG检出233例,阳性检出率69.14%。结合术中脑皮层电图监测,86例手术治疗的患者癫痫灶MEG精确定位率91.86%,V-EEG为61.63%,而对海马硬化检出率后者高于前者。药物治疗的251例癫痫患者6个月后复查MEG、V-EEG,治愈率31.87%,有效率达86.06%。手术治疗的86例患者术后6个月复查MEG、V-EEG,治愈率53.49%(46/86),有效率达90.70%(78/86)。结论脑磁图和视频脑电图的临床应用是癫痫诊治最为可靠的检测手段之一,也是判别癫痫发作类型,抗癫痫药物选择、评价药物疗效及选择停药时机的重要依据,对癫痫外科术前评估更是不可或缺的重要手段。Objective To evaluate the value of magnetoencephalography（MEG） and video-electroencephalogram（V-EEG） to the diagnosis and treatment of epilepsy. Methods MEG,MRI and V-EEG were perforemed for the diagnosis of epilepsy and location of epiletogenic foci in 337 patients with epilepsy,of whom,251 were conservatively treated by antiepileptic drugs and 86 were treated by surgery. All the patients were followed up by MEG and V-EEG 6 and 12 months after the treatment. Results The epileptiform sharp/ spike discharges were detected in 319 patients（94.66%） by MEG before the treatment. The epilepsy was diagnosed as in 233 patients（69.14%） by V-EEG before the treatment. The epiletogenic foci located by MEG and V-EEG were in concordance with those located by intraoperative electrocorticography（EcoG） in 79（91.86%） and 53（66.63%） of 86 patients undergoing surgery. The detected rate of the hippocampal sclerosis by V-EEG was higher than that by MEG. The following up 6 months after the treatment showed that curative rates were 31.87% and 53.49% and effective rates were 86.06% and 90.70% respectively in 251 patients treated by the antiepileptic drugs and 86 patients treated by the surgery. Conclusions MEG and V-EEG are effective methods to diagnose epilepsy. They are importantly helpful to distinguishing seizure type,selection of the antiepileptic drug,evaluation of the curative effects of the antiepileptic drugs and surgery,and selection of the opportunity for drug withdrawal.

关 键 词：癫痫 视频脑电图 脑磁图 诊断 治疗 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]