伴全面放电的局灶性癫痫的临床特征及手术治疗  

Clinical features and surgical treatment of patients with focal epileptogenic lesions and general interictal epileptiform discharges

作　　者：马炜[1] 王超[1] 李焕发[1] 王为文 井晓荣[1] 董珊[1] 张华[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《中国临床神经外科杂志》2016年第9期521-522,575,共3页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81271433)

摘　　要：目的 探讨伴有全面性发作间期癫痫样放电（GIEDs）的局灶性癫痫患者的临床特征及手术疗效。方法 回顾性分析2011年1月至2014年6月收治的733例MRI显示有局部异常的癫痫患者的临床资料,发作间期出现全导联同步异常放电（包括同时有局灶性异常放电形式）60例（伴GIEDs组）,673例没有这种表现（不伴GIEDs组）。伴GIEDs组中,19例采用手术治疗。结果伴GIEDs组起病年龄≤12岁比例（80.0%,48/60）明显高于不伴GIEDs组（46.2%,311/673;P〈0.05）。伴GIEDs组病变位于额叶比例（43.3%,26/60）明显高于不伴GIEDs组（22.1%,149/673;P〈0.05）,而伴GIEDs组病变位于颞叶比例（41.7%,25/60）明显低于不伴GIEDs组（56.5%,380/673;P〈0.05）。19例手术治疗患者术后随访1年以上,无明显永久的神经功能损伤,发作控制效果按Engel分级：Ⅰ级13例,Ⅱ级2例,Ⅲ-Ⅳ级4例。结论 局灶性癫痫患者可伴有GIEDs,手术治疗或可为该类患者提供一定的获益。Objective To explore the clinical features and surgical outcomes of patients with focal epileptogenic lesions and general interictal epileptiform discharges （GIEDs）. Method The electrophysiological and clinical data of 733 patients with focal epileptogenic lesions proved by MRI and GIEDs were analyzed retrospectively. Results The patients with GIEDs accounted for 8.2% （60/733） of the patients with focal epileptogenic lesions. There were features including younger age on seizure onset [patients with age ≤12 years accounted for 80.0% （48/60） of all the patients with GIEDs], more lesions （14.9%, 26/175） located in the frontal lobe and a higher ratio of male to female （42：18） in 60 patients with IEDs. Of the 19 patients who underwent surgery and were followed up over 1 year, 13 belonged in Engel＇s class Ⅰ, 2 in class Ⅱ, 4 in class Ⅲ-Ⅳ. Conclusions GIEDs may appear in epilepsy patients with focal lesion, and surgical treatment is helpful to improving the prognosis in these patients.

关 键 词：局灶性癫痫 全面性放电 脑电图 手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]