头皮脑电图在不同类型局灶性皮层发育不良所致难治性癫痫中的定位价值  

Localtion value of scalp EEG in patients with intractable epilepsy of differentpathological types caused by focal cortical dysplasia

作　　者：陈述花[1] 王静[1] 刘兴洲[1] 闫兆芬[1] 林娟霞[1] 

机构地区：[1]北京三博脑科医院(首都医科大学第十一临床医学院),北京100093

出　　处：《癫痫与神经电生理学杂志》2014年第2期69-74,共6页Journal of Epileptology and Electroneurophysiology(China)

基　　金：国家临床重点专科项目子课题（SG2011-02-2-1）国家临床重点专科项目子课题（SG2011-02-23）北京市重点实验室资助项目

摘　　要：目的：研究头皮脑电图（EEG）在不同病理学类型局灶性皮层发育不良（FCD）所致难治性癫痫中的定位作用。方法：病理学证实的皮层发育不良性难治性癫痫患者91例，其中男54例，女37例，平均年龄（12．7±9．76）岁。根据2011年国际抗癫痫联盟推荐的皮层发育不良分类方法进行分类。所有患者术前均进行长程视频脑电图（V—EEG）监测，部分患者颅内电极植人后进行颅内电极EEG记录。对间歇期头皮EEG痫样放电部位和发作起始区与FCD部位之间的关系进行分析，规定间歇期痫样放电部位和发作起始区与FCD部位部分和（或）完全一致者为二者一致，否则为不一致。结果：91例FCD患者中，FCDIa10例，FCDIb21例，FCDlIa19例，FCDⅡb20例，FCDⅢ21例。其中，头皮EEG间歇期痫样放电部位和FCD部位一致者72例，占79％；但不同FCD类型之间，二者一致性比较差异无统计学意义（Fisher精确检验P一0．391）。在FCD部位与发作起始区的一致性方面，82％（75／91）的患者FCD部位与头皮EEG发作起始区一致，并且不同FCD类型之间，二者一致性差异有统计学意义（Fisher精确检验P=-0．043），FCDIb一致性最高（100％），其次为FCDⅢ型（86％），FCDⅡa、FCDIIb和FCDIa基本相似，分别为79％、70％和70％）。结论：各型FCD所致的难治性癫痫中，FCD部位与头皮EEG间歇期痫样放电部位和发作起始区一致性非常高，在致痫区的定位中三者互相补充，可提高定位的准确性。间歇期痫样放电部位可能与FCD病理学分型无关，而发作起始区可能与FCD类型有一定关系。Objective： To study the location value of scalp electroencephalography （EEG） in pa- tients with intractable epilepsy of focal cortical dysplasia different pathological types. Methods：91 patients （male54..female 37）,aged 12. 7 ~ 9. 76 years, with a histopathological diagnosis of FCD （ based on the consensus classification proposed by aa ad hoc Task Force of the ILAE Diagnostic Methods Commis- sion）. All patients were examined by long-term scalp video EEG before operation and some of them were also monitored by long-term intracranial EEG. The relationship between the location of interictal dischar- ges or seizure onset zone on scalp EEG and FCD focus was analyzed respectively. It was defined as consis- tence between the location of interictal discharges or seizure onset zone and FCD focus if they were par- tially or completely consistent. Results：Of 91 patients,there were 10 with FCD I a,21 with FCD I b,19 with FCD 11 a,20 with FCD 11 b,and 21 with FCD I]I ,in which 79.12% （72/91） and 82.42% （75/91） gained consistence between the location of interictal discharges and/or seizure onset zone and FCD focus. For the consistence between the location of interictal discharges and FCD focus,there were no significant difference between the different types of FCD （Fisher exact test, P= 0. 391 ）, but the significant differ- ence among the different types of FCD was demonstrated in the consistence between the seizure onset zone and FCD focus （Fisher exact test, P ~ 0. 043） with the highest was FCD ][ （100 ~） followed by FCD 1]I （85.71%） ,FCD ]] a（78. 95~）, FCD ~ b（70~）, and FCD I a（70 ~//0）. Conclusion.. In patients with in- tractable epilepsy focal cortical dysplasia of different pathological types saused by there were great consis- tence between the location of interictal discharges and seizure onset zone on scalp EEG and FCD focus. The accuracy of location of epileptogenic zone will probably be improved when combined with all the three. There are no relationship between t

关 键 词：局灶性皮层发育不良(FCD) 难治性癫痫 脑电图(EEG) 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]