非特异性慢性脑炎所致的难治性癫痫的手术及其疗效分析  

Curative effect of surgery on refractory epilepsy induced by non-specific chronic encephalitis

作　　者：叶忠兴[1] 林元相[1] 康德智[1] 林章雅[1] 黄小芬[1] 王丰[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005

出　　处：《中国临床神经外科杂志》2013年第2期76-78,85,共4页Chinese Journal of Clinical Neurosurgery

基　　金：福建省自然科学基金项目(2011J01164)

摘　　要：目的探讨非特异性慢性脑炎所致的难治性癫痫(NCERE)的手术及其疗效,以提高对本病的认识。方法回顾性分析6例NCERE患者的临床资料。结果 6例均为简单或复杂部分性发作继发全面性发作,脑电图为轻至中度异常,5例MRI有异常。其中3例为顽固性癫痫持续状态(RSE)。全部行癫痫灶切除术,加海马杏仁体切除术2例,加软膜下横切术2例。病理学诊断为非特异性慢性脑炎,4例伴胶质细胞增生,3例伴皮质发育不良。按Engel分级评估预后,Ⅰ级2例,Ⅱ级1例,Ⅲ级2例,Ⅳ级1例;3例RSE疗效均不满意。结论 NCERE有其自身的特点,但尚不能肯定是独立的疾病范畴。手术效果不佳,RSE可作为判断预后较差的参考指标之一。Objective To explore surgical technique for the refractory epilepsy （RE） induced by non-specific chronic encephalitis （NSCE） and curative effect of surgery on RE. Methods The clinical data of 6 patients with RE induced by NSCE, who underwent surgery under monitoring intraoperative electrocephalogram （EEG） from April, 2008 to August, 2010, were analyzed retrospectively, including clinical manifestations, EEG, imaging data, surgical method, curative effect and so on. Results EEG was mildly or moderately abnormal in all the patients. The encephalodialysis in 3 patients, the abnormal signal in 2 patients and no abnormal findings in I patient were shown by MRI. The resection of the epileptogenic loci in 2 patients, the resection of the epileptogenic loci plus amygdalo-hippoeampectomy in 2 patients and resection of the epileptogenic foc~ plus multiple subpial transection in 2 patients were pedbrmed. The pathological examination showed that there was non-specific chronic encephalitis in all the patients, there was glial cell proliferation in 4 patients and there was focal cortical dysplasia in 3 patients. Of 6 patients, 2 had Engel gradeⅠ therapeutic outcome, 1 grade Ⅱand 2 grade Ⅲ, 1 grade IV. Conclusion The curative effect of surgery on the refractory induced by NSCE is not ideal, especially in the patients with refractory epileptic state.

关 键 词：非特异性慢性脑炎 癫痫 手术 疗效 

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]