耐药性颞叶内侧癫痫发作前期海马脑电特征分析  

Analysis of preictal hippocampal EEG characteristics in patients with pharmacoresistant mesial temporal lobe epilepsy

作　　者：任思颖[1] 伍国锋[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：《中华神经外科杂志》2013年第8期825-828,共4页Chinese Journal of Neurosurgery

摘　　要：目的观察耐药性颞叶内侧癫痫患者发作前期海马电极脑电活动特点，为判断和切除癫痫病灶提供神经电生理学依据。方法对16例非侵入性手段难以明确病灶的耐药性颞叶内侧癫痫患者进行双侧海马电极监测，患者停用抗癫痫药在非麻醉状态下监测48～72h，分析癫痫发作前期海马电极脑电图资料，探讨耐药性颞叶内侧癫痫发作前期海马电极脑电活动特点。结果16例发作间期记录到背景活动基础上出现局限于某几个电极点的阵发性高幅慢波1例、发作性快波节律1例、棘波或棘尖慢复合波14例，视为异常脑电活动；经过48—72h监测，10例监测到33次临床癫痫发作，发作起始期海马电极均可记录到清晰可辨的癫痫样脑电波形。结论颞叶内侧癫痫临床发作起始期海马电极癫痫样放电清晰可辨，部位局限，易于确定癫痫性活动起源部位。对于非侵入性手段难以判断癫痫样放电起源的颞叶内侧癫痫可采用脑立体定向技术植入海马深部电极进行脑电监测。Objective To observe the characteristics of preictal hippocampal depth electrode EEG in patients with pharmacoresistant mesial temporal lobe epilepsy, and to accumulate experiences for judgement of epiletic focus and to provide neuroelectrophysiological evidences for surgical resection of epileptic focus. Methods Depth electrode was implanted into bilateral hippocampus of patients with pharmacoresistant mesial temporal lobe epilepsy. Hippocampal depth electrode EEG monitoring lasted for 48 -72 hours with the patients＇AED discontinued, and then the preictal hippocampal EEG data of the 16 patients were analyzed to observe the features of the epileptiform discharges recorded by hippocampal depth electrode. Results 16 patients experienced monitoring for 48 - 72 hours, 33 epileptic seizures in 10 patients were detected. The interictal waveform of EEG from each electrode contact was similar to others, Paroxysmal high amplitude and slow wave in 1 patient, paroxysmal fast frequency in 1 patient and spike and slow wave complex in 14 patients on the background were considered to be abnormal electrical activity. Legible EEG waveform was recorded by hippocampal electrode inl6 patients during epileptic seizures. The onset of epileptiform discharges manifested with locally original electrical activity with high amplitude and fast frequency in 1 patient（ 16 Hz） and slow waveform rhythm in 1 patient and continuous sharp rhythm in 10 patients and slow wave complex or spike and slow wave complex in 4 patient on basic background activity. The epileptogenic focus is located in the left anterior prehippocampus in 8 patients and in the right anterior prehippocampus in 4 patients and in bilateral hippocampal in 4 patients. Conclusions Hippocampal electrode EEG waveform in patients with pharmacoresistant mesial temporal lobe epilepsy was legible. The epileptiform discharges were limited to some dectrode contacts. So the epileptogenic zone could be easily determined. If epileptogenic focus could not be determined by scalp EEG or ot

关 键 词：颞叶内侧癫痫 海马 深部电极 立体定向技术 视频脑电图 海马脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]