间断性海马电刺激治疗顽固性颞叶癫痫的研究  

The study of hippocampal intermittent electrical stimulation treatment for intractableepilepsy

作　　者：田宏[1] 石祥恩[2] 左焕琮[1] 周文静[1] 林久銮[1] 石岩芳[1] 

机构地区：[1]清华大学玉泉医院神经外科,北京100049 [2]首都医科大学附属复兴医院神经外科

出　　处：《中华神经外科杂志》2013年第8期821-824,共4页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项项目（首发2011-4032-01）

摘　　要：目的探讨间断性电刺激海马结构治疗顽固性颞叶癫痫。方法对10例颞叶内侧型癫痫的患者行立体定向经枕入路钻孔，沿海马长轴置入脑深部普通4导电极；视频脑电监测并定侧定位致痫灶（海马）；选择刺激区域，给予高频低电流间断电刺激，每天分别选取同一时间段刺激2次，间隔6h，连续刺激2～3d。在刺激区域记录脑电活动，并分析和统计刺激前、后的棘波数量变化。结果在电刺激期间，6例刺激前、后比较棘波数减少〉50％，3例减少〉30％，1例效果不明显，棘波数减少〈10％。10例经急性电刺激前、后棘波数比较，影像未显示海马硬化的病例较有海马硬化的病例棘波数减少幅度大。结论通过统计电刺激前后脑电图中棘波数量的变化，呈现出棘波数明显减少，证实了间断电刺激海马治疗颞叶内侧型癫痫的有效性和可行性。Objective To discuss the treatment of intractable temporal lobe epilepsy by intermittent electrical stimulation of the hippocampal formation. Method 10 patients with mesial temporal lobe epilepsy were analyzed in this study. Diagnostic 4 contact electrodes were stereotactically implanted by means of a parasagittal occipital approach, directed along the hippocampus with contact one placed in the amygdala. Video EEC monitoring and locate the Epileptic loci （Hippocampal） were performed. The area was selected and stimulated intermittently with high - frequency low current. The stimulation was taken place twice at the same period daily with six - hour interval for 2 to 3 days in succession. The brain wave were recorded activity in the stimulated area. The variation of spike waves were analyzed in quantity. Result During the electrical treatment, six patients showed a decrease by over 50% in the spike wave quantity. Same situation was observed in the other three patients, with a reduction of above 30%. However, the treatment is not so effective to one patient, in which the spike wave quantity was decreased less than 10%. Comparing the number of spike waves before and after the acute electrical stimulation, the fact is that patients with magnetic resonance imaging （MRI） no hippocampal sclerosis has a larger range of reduction in quantity than that of patients with hippocampal sclerosis. Conclusion Statistic research about the variation of spike wave quantity in EEG indicates a significant reduction after electrical stimulation, which leads to the confirmation of the effectiveness and feasibility of treating the mesial temporal Iobe epilepsy through intermittent electrical stimulation of the hippocampal formation.

关 键 词：脑深部电刺激术 海马 颞叶癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]