难治性颞叶癫痫头皮脑电发作起始形式与致痫病变的关系  

Relationship between seizure-onset patterns of scalp EEG and epileptogenic lesions in intractable temporal lobe epilepsy

作　　者：陶园 但炜[1] 周超[1] 孙超[1] 谢延风[1] 石全红[1] 詹彦[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2017年第22期2220-2225,共6页Journal of Third Military Medical University

基　　金：重庆市卫生局重点课题(2012-1-008);国家临床重点专科建设项目经费资助[(2011)170号]~~

摘　　要：目的观察难治性颞叶癫痫(intractable temporal lobe epilepsy,ITLE)患者头皮脑电发作起始形式,并探讨其与致痫病变的关系。方法回顾性分析我院神经外科2011年9月至2015年9月45例ITLE患者的临床信息及其172次临床发作的视频脑电图资料,所有病例行切除性癫痫手术治疗,术后效果评估均为EngelⅠ级。根据术前MRI所示致痫病变部位的不同分为颞叶内侧癫痫(mesial temporal lobe epilepsy,MTLE)和颞叶新皮层癫痫(neocortical temporal lobe epilepsy,NTLE);术后病检可见6种不同病理类型。对发作期脑电起始形式进行分析,比较各种起始形式在不同部位及不同性质致痫病变的出现差异,探讨不同发作起始形式对致痫灶的定位价值及可能的神经电生理机制。结果 (1)45例患者172次临床发作期脑电中有明显起始形式157次,包括低幅快活动(low-voltage fast activity,LVFA)57次(36.3%),θ节律35次(22.3%),δ活动31次(19.7%),尖波活动20次(12.7%),低中幅多棘波14次(8.9%)。157次发作期脑电中局灶性起源103次(65.6%),LVFA占49次(47.6%),LVFA的定位率明显高于其他起始形式(P<0.01)。(2)5种起始形式均可见于MTLE和NTLE,LVFA在NTLE的出现率明显高于MTLE(P<0.01),慢活动(θ节律及δ活动)在MTLE的出现率高于NTLE(P<0.05),尖波活动及低中幅多棘波在不同部位的出现差异无统计学意义(P>0.05)。(3)5种起始形式可见于不同性质的致痫病变,θ节律在海马硬化(hippocampal sclerosis,HS)病变中的出现率高于其他病变类型(P<0.05)。结论 ITLE发作期头皮脑电起始形式中LVFA有较好定位价值,θ节律对HS具有提示意义。Objective To investigate the relationship between seizure-onset patterns of scalp EEG and epileptogenic lesions in patients with intractable temporal lobe epilepsy（ ITLE）. Methods Between September,2011 and September,2015,45 patients with ITLE were treated in our hospital and their clinical and video EEG（ V-EEG; 172 recordings） data were analyzed retrospectively. All the patients underwent surgical resection of the epileptogenic lesions（ Engel Grade Ⅰ by postoperative evaluation） and were followed up for at least 1 year. According to the preoperative magnetic resonance imaging（ MRI） of the epileptogenic lesions,the patients were divided into mesial temporal lobe epilepsy（ MTLE） and neocortical temporal lobe epilepsy（ NTLE） groups; 6 different pathological types of the lesions were identified after the surgery. The seizure-onset patterns of the patients were analyzed,and the frequencies of the patterns were compared among patients with lesions at different sites and of different pathological types. Results Of the 172 video scalp EEG recordings during clinical onset, obvious seizure-onset patterns were identified in 157 recordings,including 57（ 36. 3%） showing low-voltage fast activity（ LVFA）,35 showing（ 22. 3%） θ rhythm,31（ 19. 7%） showing δ activity,20（ 12. 7%） showing sharp wave activity and 14（ 8. 9%） showing low or moderate amplitude polyspikes. Of the 157 recordings with clear seizure-onset patterns,localized patterns were found in 103 recordings（ 65. 6%） including 49（ 47. 6%） showing LVFA,whose localization rate was significantly higher than that of other patterns（ 49/57 vs 54/100,P 0. 01）. The 5 seizure-onset patterns were seen in both MTLE and NTLE,but LVFA was more frequently found in NTLE than in MTLE（ 46/89 vs11/68,P 0. 01）,and slow activity（ θ rhythm and δ activity） was more frequent in MTLE than in NTLE（ 43/68 vs 23/89,P 0. 05）. The frequencies of sharp wave activity and low or moderate amplitude polyspikes were similar betw

关 键 词：难治性颞叶癫痫 发作期头皮脑电 致痫病变 低幅快活动 

分 类 号：R181.32[医药卫生—流行病学] R741.044[医药卫生—公共卫生与预防医学]