隐源性癫痫致痫灶最常见好发部位及相关病理特征  

The favorite location and postoperative pathology of the cryptogenic epileptogenic focus

作　　者：祁晓刚[1] 朱战鹏[1] 孙立超[1] 邱吉庆[1] 

机构地区：[1]吉林大学白求恩第一医院神经内科癫痫中心,吉林长春130021

出　　处：《中风与神经疾病杂志》2013年第6期538-541,共4页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技发展计划项目(No.20110469)

摘　　要：目的回顾性分析隐源性癫痫致痫灶最常见的好发部位及手术切除标本的病理改变,探讨隐源性癫痫致痫灶的发病机制。方法通过向26例头部CT、MRI等影像学检查无特异性表现的患者颅内可疑脑区植入皮层电极及深部电极,行长程视频脑电监测,记录发作间期及发作期脑电图变化,确定癫痫病灶起始区,手术切除致痫灶并送病理,术后定期随访。结果 26例均可以明确致痫灶,其中癫痫发作单独起源于颞叶新皮层及颞叶内侧的13例,占本组病例的50%;送检标本病理结果显示胶质细胞增生、皮层分层紊乱25例,占本组病例的96.15%,其中伴有海马硬化14例。术后随访1年以上,Engel I级15例,Engel II级8例,Engel III级2例,Engel IV级1例。无严重并发症及手术死亡病例。结论颞叶新皮层及颞叶内侧是隐源性癫痫致痫灶最常见的好发部位,皮层发育不良是隐源性癫痫手术切除标本中常见的病理改变,其中海马硬化是颞叶内侧常见的病理改变。颞叶新皮层及颞叶内侧病理改变不仅经常相伴出现,而且病理改变轻微。通过外科干预,效果较满意。按Engel分级,位于颞叶新皮层及颞叶内侧的病例手术疗效较其他好,Engel’s分级均在II级以上。Objective Through a retrospective analysis of the cryptogenic epilepsy,We made a summing up of the favorite location and postoperative pathology of the epileptogenic focus and explored the pathogenesis of the epileptogenic focus.Methods 26 cases,whose CT and MRI of the head showed no specific changes,were implanted intracranial electrodes after a preoperative evaluation.By monitoring the VEEG,We found the starting areas of the epileptogenic focus and removed it through the operation.Results All patients had more than one year follow-up after surgery.We found 15 cases were seizure free（Engel I）,seizure frequence reduced markedly in 8 cases（Engel II）,2 cases in Engel III and 1 case had no effect（Engel IV）.Conclusion The epileptogenic focus of the cryptogenic epilepsy are mostly found within the medial temporal lobe and temporal lobe cortex.The cortex dysplasia of the temporal lobe is the most common pathological changes and hippocampal sclerosis is a common pathological changes of the inside of the temporal lobe.This dual pathological changes not only often go hand in hand,but also the slight changes.According to the grade of Engel,those cases located in the medial temporal lobe and temporal lobe obtain better effect after operation and Engel ＇s classification are all better than Engel II.

关 键 词：隐源性癫痫 颅内电极 好发部位 

分 类 号：R742.1[医药卫生—神经病学与精神病学]