皮质发育不良癫痫发作间期脑电图在术前评估的定位价值  

The significance of interictal scalp EEG in the presurgical evaluation of the patients with focal cortical dysplasia

作　　者：梅珍[1] 

机构地区：[1]南京军区福州总医院神经外科癫痫中心,福建福州350025

出　　处：《癫痫与神经电生理学杂志》2016年第4期217-221,共5页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨头皮脑电图（EEG）在局灶性皮质发育不良（{ocalcorticaldysplasia，FCD）癫痫病人发作间期的特点及定位致痫区的意义。方法：选择自2010年5月～2013年5月我中心收治的50例行颅内电极埋置术，并经病理证实为FCD的患者为研究对象。将颅内电极脑电图（intracraniale—lectrodes EEG，IEEG）发作间期放电（interictal discharge，IID）与头皮脑电图（EEG）IID分为四种类型：A型独立棘波；B型重复棘慢波；C型多棘波；D型阵发性快活动。IEEG发作期放电（ictaldischarg，ID）分为3型：I型阵发性快活动；Ⅱ型棘波节律；Ⅲ型小于8Hz的节律性电活动。将50例患者头皮EEG-IID与IEEG-ID分析比较。结果：50例头皮EEG-liD的A、B、C、D各型的波形、部位与IEEG-ID相比，其间均有显著性差异。6例头皮EEG-IID在D型中，5例IEEG-ID为I型，术后随访预后均为EngleI级；10例头皮EEG-ID在C型中，7例IEEG-ID为I型，术后随访为EngleI级的6例；C、D型EngleI级12例。而头皮EEG-IID中A型16例，术后随访EngleI级的4例，定位意义明显弱于其它类型。结论：50例中头皮EEG-IID以棘波、尖波波形较为多见，且范围较IEEG-IID广泛。经过由皮层到头皮的传导，不论是lID还是ID，异常放电形式均有可能发生改变。头皮EEG的c、D型lID较为局限，定位可靠性较高。Objective：To discuss the characteristics and significance of interictal scalp EEG in the presurgical evaluation of patients with epilepsy of focal cortical dysplasia（FCD）. Methods： Twenty-five subjects were collected,who underwent epileptic surgeries consecutively in our center from May 2010 to May 2013. All patients underwent intracranial electrode implantation and long-term video EEG monitoring before surgery and all the postoperative pathologies were proved to be FCD. The scalp EEG of the 50 pa- tients were analyzed including interictal discharges （IID）and ictal discharges （ID）. lid were divided into four types. A, isolated spikes ; B, repetitive spike-wave pattern ; C, poly spikes-wave pattern ; D, paroxysmal fast activity. ID were classified as Type I ：paroxysmal fast activity, Type Ⅱ ：repetitive spikes and Type Ⅲ： slow rhythmic activity less than 8 Hz. The interictal discharge on scalp EEG was compared with ID of intracranial electrodes in order to clarify the significance and locating value of the scalp EEG. Results：The type of interictal scalp EEG is not consistent with that of intracranial EEG and the difference between them was significant. IID in 6 cases blonged to Type D;The scalp EEG in 5 cases belonged to Type I rID of all cases in the intracranial electrodes during follow-up were Engle I. Out of 10 cases with Type C ofIID in the scalp EEG, 7 cases belonged to Type I of ID on the intracranial electrodes,6 cases bleonged to Engle I：Type D and Type C in 12 cases belonged to Engle I;Of 16 cases of Type A on the scalp EEG,on- ly 4 cases were Engle I,which had less localing significance than any other IID types in the scalp EEG. Conclusion：Spike or sharp waves are the most common IID types on the scalp EEG in patients with epi- leptic FCD,which usually have more wide distrihutiot and less localing value. Both the liD and 1D types can change their forms of discharge from the cortex to the scalp. Type C and D of IID in the scalp EEG show higher localing value.

关 键 词：局灶性皮质发育不良(FCD) 癫痫 头皮脑电图(头皮EEG) 颅内电极脑电图(IEEG) 发作间期放电(IID) 发作期放电(ID) 

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]