脑立体定向植入海马电极监测颞叶内侧癫痫的临床研究  

Clinical study on mesial temporal lobe epilepsy monitored by stereotactic implantation of depthelectrode into hippocampus

作　　者：孙良先[1] 伍国锋[1] 任思颖[1] 秦冠南[1] 毛远红[1] 

机构地区：[1]贵阳医学院附属医院神经内科,550004

出　　处：《中华神经科杂志》2012年第4期233-237,共5页Chinese Journal of Neurology

摘　　要：目的观察应用脑立体定向微创穿刺技术植入海马电极监测颞叶内侧癫痫的效果。方法13例耐药性颞叶内侧癫痫患者，主要表现为复杂部分性癫痫发作及继发性全身强直阵挛性发作。根据临床症状、MRI等资料初步确定癫痫灶位于海马区域，在脑立体定向仪引导下于双侧海马植入8-触点深部电极，监测24～72h，从而确认癫痫灶是否位于海马区域。结果13例患者经过72h监测，共监测到7例有29次临床发作，发作期脑电变化表现为在背景波形基础上出现阵发性高幅慢波或棘尖慢复合波，从某个电极点开始，迅速扩展到同侧其他电极点甚至对侧电极；头皮脑电在延迟1-2s后出现3～4Hz的高幅8节律。6例未监测到临床发作的患者，海马电极监测到发作性局灶性高幅慢波或尖慢综合波，而头皮电极未监测到明显异常。13例患者中6例接受选择性海马杏仁核切除或立体定向病灶损毁术，随访3-8个月，效果满意。结论脑立体定向植入海马电极监测颞叶内侧癫痫是一种安全可靠的方法，可以判断癫痫病灶的起源，为外科进行选择性海马杏仁核切除提供有力依据，对于视频脑电图或其他手段难以记录到癫痫样波形或难以判断癫痫样放电起源的患者可进行脑立体定向深部电极脑电图监测。Objective To observe the effects of stereotactic implanting depth electrode into the hippocampus on monitoring mesial temporal lobe epilepsy. Methods Thirteen patients with pharmaeoresistant epilepsy were included in the present study. The epileptogenic zone might he located in the hippocampus based on the symptoms and MRI data. Eight-contact depth electrode was implanted into the patients＇ hippocampus by stereotactie procedures to record the electroencephalogram（EEG）. The duration of monitoring lasted for 24--72 hours or more, so as to be sure if the epileptogenic zone was located in the hippocampus, and to provide evidences for surgical resection of epileptic focus. Results Thirteen patients with mesial temporal lobe epilepsy underwent video electroencephalogram monitoring for 72 hours. Twenty- nine epileptic seizures in 7 patients were detected. Ictal EEG changes manifested as paroxysmal slow wave or spike and slow waves on the background. The epileptiform discharges started from some electrode points, and then propagated to others or the contralateral electrode. After 1-2 seconds of delay, high amplitude slow waves with the frequency of 3-4 Hz were observed on the ipsilateral scalp EEG. Clinical epileptic seizures were not detected in 6 patients during monitoring, depth electrode showed paroxysmal focal high amplitude slow wave or spike and sharp waves, scalp EEG did not find abnormality. Six of thirteen patients received surgical resection of epileptic foci, the outcome during follow-up of 3-8 months was satisfactory. Conclusions To record hippocampal EEG in patients with intractable epilepsy by stereotactic implanting depth electrode into the hippocampus might be a safe and reliable method. It might provide strong evidences for the diagnosis of patients with mesial temporal lobe epilepsy, and for the location of epileptogenic zone.

关 键 词：癫痫 颞叶 海马 电极 植入 立体定位技术 脑电描记术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]