局灶颞叶外癫痫间期痫样放电的分布与手术疗效的关系  

The relationship between distribution of interictal epileptiform discharges and surgical outcomes in patients with focal extratemporal lesions

作　　者：李焕发[1] 张华[1] 王超[1] 武昊[1] 董珊[1] 刘备[1] 井晓荣[1] 

机构地区：[1]第四军医大学唐都医院神经外科,陕西西安710038

出　　处：《中华神经外科疾病研究杂志》2015年第6期528-530,共3页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(81271433)

摘　　要：目的探讨MRI显示为颞叶外局灶病变的癫痫患者发作间期痫样放电的分布与手术疗效的关系。方法回顾性分析106例磁共振显示颞叶外局灶病变的癫痫患者的电生理、影像、手术及术后随访资料。根据发作间期痫样放电的分布将病例分为三组，A组为间期正常范围脑电图，B组为间期痫样放电仅分布于病变所在脑叶，c组为间期痫放电超出病变所在脑叶。结果病变分布包括额叶57例，顶叶29例，枕叶17例，岛叶2例，下丘脑1例。间期痫样放电分布为A组占28．3％（30／106），B组占29．2％（31／106），C组占42．5％（45／106）。手术均行病变切除或立体定向毁损术，术后随访12-52个月，平均28个月，各组按Engel分级，A组：I级23例，Ⅱ级2例，Ⅲ级2例，Ⅳ级2例；B组：I级21例，Ⅱ级3例，Ⅲ级4例，Ⅳ级2例；C组：I级27例，Ⅱ级6例，Ⅲ级3例，Ⅳ级3例，各组间疗效没有统计学差异（P〉0．05）。结论MRI显示为局灶颞叶外病变的癫痫患者手术切除或立体定向毁损病变能取得很好的控制疗效，且疗效与发作间期痫样放电的分布无关。Objective The study aims to probe into the relationship between distribution of interletal epileptiform discharges （IEDs） and surgical outcome in patients with a focal extratemporal lesion. Methods We retrospectively analyzed electrophysiology, imaging, surgery and follow-up data of 106 epilepsy patients with a focal extratemperal lesion, and we divided the patients into three groups based on the distribution of IEDs, group A with normal interictal EEG, group B with IEDs locating at lesioned lobe, group C with IEDs exceeded lesioned lobe. Results MRI-documented lesions located at frontal （57）, parietal （29）, occipital （17）, insular （2） and hypothalamus （1）. According to the distribution of IEDs, 28.3% （30/106） of patients in group A, 29.2% （31/ 106） in group B and 42.5% （45/106） in group C. All of the patients underwent surgical resection or stereotactic surgery, and the follow-up duration was 12 to 52 months （mean 28 months ）. The surgical outcomes were performed using the Engel classification, including group A： Engel I： 23, II： 2, m： 2, IV： 2; group B： Engel 1： 21, II： 3, HI： 4, IV： 2; and group C： Engel Ⅰ： 27, Ⅱ： 6, Ⅲ： 3, and IV： 3. There was no statistical significant difference between different groups （P 〉 0.05）. Conclusion A good seizure control can be achieved by surgical resection or stereotactic surgery for patients with a focal extratemporal lesion, and the surgical outcome had no association with the distribution of IEDs.

关 键 词：颞叶外癫痫 局灶 痫样放电 手术疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]