81例局灶性皮质发育不良Ⅱ型的临床及预后分析  

Focal cortical dysplasia type Ⅱ ： clinical features and surgical outcome in 81 patients

作　　者：刘长青[1] 陈凯[1] 栾国明[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),癫痫病临床医学研究北京市重点实验室,北京脑重大疾病研究院癫痫所,100093

出　　处：《中华神经外科杂志》2014年第5期493-496,共4页Chinese Journal of Neurosurgery

基　　金：国家科技支撑计划项目（2012BA103802）;首都临床特色应用研究项目（Z13110700220000）;国家临床重点专科项目（SG2011-02-1-3）

摘　　要：目的探讨局灶性皮质发育不良（FCD）Ⅱ型各亚型的临床特点和手术预后。方法回顾性分析2008年3月到2011年12月北京三博脑科医院癫痫中心收治的81名FCDⅡ型患者的临床资料并进行术后随访。结果FCDⅡA46例，FCDⅡB35例，FCDⅡA主要位于颞叶，FCDⅡB主要位于额叶和顶叶，52名（64．2％）患者术后1年达到EngeⅡ级。致痫灶完整切除癫痫预后更好。结论手术完整切除是FCDII型最佳的治疗措施，FCDⅡA和FCDⅡB术后癫痫缓解差异无统计学意义。Objective To analyze the clinical features and the prognostic factors of seizure outcome after surgical treatment for focal cortical dysplasia （FCD） type Ⅱ Methods 81 cases of patients were retrospectively studied, who were diagnosed as focal cortical dysplasia by postsurgical pathology at Beijing Sanbo Brain Hospital during March 2008 and December 2011. Clinical features, seizure history, and operation information were collected for statistical analysis on prognostic indicators of postoperative seizure outcomes. Results 52（64. 2% ） in all 81 patients achieved Engel class I seizure outcome one year after surgery, while 28（60. 9% ） in 46 FCD Type Ⅱ A patients and 24（68.5% ） in 35 FCD H B patients became seizure free in the same fallow-up period. FCD type ⅡA was mainly located at temporal lobe and type ⅡB was majorly sited at frontal or parietal lobe. 24（58.5% in 41 ） pediatric patients got Engel class Ⅰ , and 28 （70. 0% in 40） adult patients were Engel class 1. 71 （87. 7% ） in all FCD type Ⅱ were positive on MR, with 40（87. 0% ） and 31 （88.6%） positive on MR in respect to subtype Ⅱ A and Ⅱ B. FCD subtype ⅡB had an earlier age at first onset than subtype Ⅱ A （4. 8 vs 7.5, P = 0. 048 ） ; extratemporal FCD typeⅡ had an earlier age at first onset than temporal FCD type Ⅱ （5.0 vs 10.7, P = 0. 030）, and patients with a history of febrile convulsion also showed an earlier age of first onset than that without such anamnesis（ 1.3 vs 6. 7, P = O. 000）. Disease-related factors such as course of seizure, age at surgery, MR positive, site of the lesion, risk factors like febrile convulsion, or the pathological subtype, had no predictive meanings on postsurgical seizure freedom. But as to the treatment-related factors, complete resection of the lesion on MRI was the most important prognosticator. Conclusion FCD subtypeⅡ A and subtype Ⅱ B are highly homogeneous in clinical features and surgical outcome. Subtype ⅡB has an earlier age at first onset than

关 键 词：局灶性皮质发育不良Ⅱ型 难治性癫痫 临床特征 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]