头颅磁共振阴性的额叶癫痫患者复合型颅内电极脑电图分析  

The characteristics of combined intracranial eleetode EEG of head MRI-negative in patients with frontal lobe epilepsy

作　　者：贾延增 杨朋范 林巧 裴家生 陈其钻 张辉建 钟忠辉 JIA Yanzeng;YANG Pengfan;LIN Qiao(Epilepsy Center,Department of Neurosurgery,Fuzhou General Hospital of Xiamen University,Fuzhou（350025）,Fujian China)

机构地区：[1]厦门大学附属东方医院(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》2018年第5期275-281,共7页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨头颅磁共振成像（MRI）检查阴性的额叶癫痫患者复合型颅内电极脑电图（EEG）的特征及致痫灶定位价值。方法：回顾分析51例经手术治疗的头颅MRI阴性的难治性额叶癫痫患者的临床资料，按照手术疗效将其，分为2组,即术后无发作组和术后有发作组。对其头皮EEG、PET-CT、复合型颅内电极EEG和临床病理特征等资料进行分析。结果：术后随访2年以上，术后元发作组（EugelⅠ级）22例，术后有发作组29例（其中,Engel Ⅱ级9例，Ⅲ级14例，Ⅳ级6例）。51例患者中，42例术后病理证实为局灶性皮质发育不良（Focal cortical dysplasia，FCD）。术前颅内电极EEG在术后无发作组患者可见发作间期痫样放电（Interictal epileptiform discharges，IEID）≥80％位于发作起始区（Seizure onsetzones，SQZ）内，有发作者则相应为72％，但两组的电发作起始波形类似，均以正弦没居多，起始频率以β-γ频段的快节律占优势；两组发作起始区均以局灶型和区域型为主，但术后无发作组局灶型和区域型发作起始的比例更大（96％对比72％），差异有统计学意义；与术后无发作的患者相比，术后有发作的患者术前颅内电极EEG发作起源放电播散达到周围区域2cm的时间更短（5.9±7．1s对比1．4±2．9s），电发作扩散波及同侧半球额叶外结构的播散时间更短（21.8±20．3s对比4．9±5.1s），比例更大（50％对比79％），电一临床延迟时间也更短（18.3±6.1s对比14．6±4.4s），差异均有统计学意义。结论：复合型颅内电极EEG在MRI阴性的额叶癫痫患者中具有较高的致痫灶定位价值。Objective. To investigate the characteristics and Yalue of combined intracranial electrode （CIE） EEG in the detection of head MRI-negative in patients with frontal lobe epilepsy. Methods： 51 patienta with head MRI-negatbze frontal lobe epilepsy underwent surgical treatment and their clinical files were analyzed retrospectively. According to the surgical outcomes, the patients were divided into two groups, the seizure-free group and the recurrent group. The characteristics of scalp-EEG, PET-CT, CIE-EEG and pathology were analyzed. Results：All patients were followed up for at least 2 years. 22 patients were in the seizure-frea group （Engel class Ⅰ） and 29 patients were in the recurrent group （9 were class Ⅱ , 14 were class Ⅲ and 6 were class Ⅳ）. Ot the 51 patients, 42 suffered from focal cortical dysplasia. More than 80% of interictal epileptiform discharges （IEDs） in CIE-EEG were inside the seizure onset zones （SOZ） and less than 10% of IEDs were outside SOZ in the seizure-free group. The same predominant morphology of EEG seigures and sinusoidal waves were found in both groups. The predominant frequency of EEG seizures was also the same and fast rhythmic activity in the beta to gamma range occurred in the two groups. As regarding to the predominant types of SOZ, both belonged to focal or regional onset. But focal or regional onset were more common in the seizure-free group（96% vs. 72%）and it was statistically significant. In comparison with the seizure-free group, the time of onset discharges spreading ≥2 cm in the recurrent group was significantly shorter （5.9±7.1 s vs. 1.4±2.9 s） ; the proportion of onset discharge spreading to other lobes was significantly higher （50% vs. 79%） and the time of spreading was significantly shorter （21.8±20. 3 s vs. 4.9±5. 1 s） ; the clinical time of CIE-EEG seizures and clinical ictal seizures （arousal/behavioral changes） was significant shorter （18.3±6.1 s vs 14.6±4.4 s） ;these differences were statistically signifi

关 键 词：磁共振成像(MRI) 癫痫 额叶 复合型颅内电极脑电图 局灶性皮质发育不良(FCD) 

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]