海马横切术对颞叶内侧型癫痫海马痫样放电的抑制作用  

The inhibitory effect of hippocampai transaction for epileptiform discharges in the Hippo- campus of mesial temporal lobe epilepsy

作　　者：吴朝晖[1] 赵全军[1] 张剑宁[1] 罗惠民[1] 赵虎林[1] 王福莉[1] 

机构地区：[1]海军总医院·中国人民解放军微创神经外科研究所,北京100048

出　　处：《癫痫与神经电生理学杂志》2014年第2期75-79,共5页Journal of Epileptology and Electroneurophysiology(China)

基　　金：首都临床特色基金研究：Z111107058811018

摘　　要：目的：评估海马横切术治疗颞叶内侧型癫痫时，术中海马痫样放电的抑制作用及其对患者智力、记忆力的影响。方法：对5例经深部电极埋藏EEG监测确定为双侧颞叶起源灶者实施了海马横切术，其中左侧2例，右侧2例，分期双侧手术1例。术中5mm间隔深部电极去除针芯后放置于海马部位，相同麻醉条件下，海马横切术前、术后分别测量EEG5min，对比每分钟痫样放电频率和波幅；手术前后进行神经心理学检查，评价手术对智商及记忆功能的影响。结果：6次进行手术的海马部位术中EEG，在海马横切术前痼样放电出现率为（16．2士3．6）次／min，波幅（478．9土59．4）“V，术后可识别痼样放电出现率（4．5±2．1）次／min，波幅（103．8士29．6）“V，术前术后配对痫样放电率和波幅的t检验差异均有统计学意义（P〈0．05）；4例手术前后神经心理学检查提示手术对智商及记忆功能无影响（P〉0．05）。结论：海马横切术可以保留海马的记忆功能，同时又能达到抑制海马部位痫样放电的目的，尤其是双颞叶癫痫，当对侧仍为起源灶时还可进行二期手术。Objective .. To evaluate the inhibition of the epileptiform discharge and the memory and intelligence quotient protection of hippocampal transaction in the treatment of mesial temporal lobe epilep- sy. Methods.. Five patients with bilateral mesial temporal lobe independent ictal discharges were treated with hippocampal transection,in which 2 were on the left side,2 were on the right side and one sase was transected on both sides by stages. In the operations,depth electrodes without corn needles and with con- tacts in 5 mm interval were placed onto the hippocampus to analyze the frequence and amplitude of the ep- ileptiform discharges with 5 min gap in EEG examination before and after operation while the same anaes- thetization,The neuropsychological examination was performed for these patients before and after opera- tion to evaluate the affect of IQ and memory function. Results.. During the 6 operations, the frequenee of epileptiform discharges of EEG in the hippocampus were （16.2 ±3.6） per min before operations and （4.5 ±2.1 ） per min after them（P〈0.05）. The amplitudes of epileptiform discharges were （478.9 ± 59.4 ）μV before operation and （103.8± 29.61） μV after them（P〈0.05）. Four cases were undergone entire pre and postoperative examinations of neuropsychology and no deficits were found in IQ and memory （P〉0.05）. Conclusion： Hippocampal transection can either retain the memory function of hippocampus or con- trol seizures. Especially in bilateral temporal lobe epilepsy,if the other side would still be the epileptogenic focus after one side transection, the ransection of other side could be performed by the second stage opera-tion.

关 键 词：颞叶癫痫 深部电极脑电图(SEEG) 海马横切术 痫样放电 智商 记忆功能 

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