惊吓性癫痫的临床、脑电图特征及手术治疗  

Startle epilepsy： clinical characteristics, EEG pattern and surgical treatment

作　　者：石岩芳[1] 左焕琮[1] 韩宏彦[1] 周文静[1] 孙朝晖[1] 林久銮[1] 

机构地区：[1]清华大学玉泉医院神经外科五病区,北京100049

出　　处：《中华神经外科杂志》2011年第6期664-667,共4页Chinese Journal of Neurosurgery

基　　金：科技部基金（2005CB522800,2004CB318101）;国家自然科学基金（30621004）;清华一裕元科学研究基金首都医学发展科研基金（2009-3048）

摘　　要：目的 探讨惊吓性癫痫的临床、脑电图（EEG）特征及手术治疗效果。方法回顾性分析经抗癫痫药物或手术治疗的9例惊吓性癫痫的临床资料，总结发作症状学，头皮EEG，颅内EEG及头颅MRI特点，随访手术治疗效果。结果所有患者的多数发作均由惊吓诱发，仅2例存在少量自发发作。8例MRI发现结构性病变，头皮EEG显示多灶性或局灶性癫痫样放电。2例行颅内电极监测，对致痫灶进行了较精确的定位。5例手术治疗，3例大脑半球切除术，2例局部癫痫灶切除。术后随访6—30个月（平均18．6个月），EngelⅠ级4例，EngelⅢ级1例。结论多数惊吓性癫痫患者存在脑的结构性损害，损害范围通常广泛，并均包含初级感觉运动区或辅助性感觉运动区。惊吓性癫痫多药物难治，手术治疗可取得较好的效果，明显改善患者的预后。Objective To study the clinical, scalp and intracranial electroencephalogram （EEG） characteristics of startle epilepsy, and its outcome of surgical treatment. Methods The clinical data of 9 patients with startle epilepsy who were treated in our hospital were reviewed retrospectively. Their scalp and intracranial EEG, and MRI were investigated. Results All of the patients were diagnosed as startle epilepsy, and most of seizures were provoked by sudden unexpected stimuli. MRI showed extensive lesions in 8 cases, scalp EEG showed mulifocality or focal epilepsic discharge in all. Intracranial electrodes monitoring were performed in 2 patients to locate the epileptogenic zone. Five patients were treated surgically, 3 of them were operated with hemispherectomy, and 2 with focal cortex resection. During 6 - 30 months follow up, the seizure outcome were Engel I grade in 4, and Engel Ⅲ grade in 1. Conclusions Most of the patients with startle epilepsy has brain lesions involving the perisensorimotor or supplementary sensorimotor area, and were refractory. Resective surgery may get satisfactory outcome.

关 键 词：惊吓性癫痫 外科手术 感觉运动区 

分 类 号：R742.1[医药卫生—神经病学与精神病学]