"难定位"难治性癫痫的临床病理特点及难定位原因分析  

Clinicopathologic characteristics and causes of difficulty in locating the"difficult to locate"intractable epilepsy

作　　者：李承俊 林元相[1] 王丰[1] 王行富[2] 姚培森[1] 余良宏[1] 康德智[1] Li Chengjun;Lin Yuanxiang;Wang Feng;Wang Xingfu;Yao Peisen;Yu Lianghong;Kang Dezhi(Department of Neurosurgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Pathology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005 [2]福建医科大学附属第一医院病理科,福州350005

出　　处：《中华医学杂志》2020年第29期2268-2272,共5页National Medical Journal of China

基　　金：福建省教育厅中青年教师教育科研项目(JAT190201);福建医科大学教授发展基金(JS15014)。

摘　　要：目的总结"难定位"难治性癫痫患者的临床病理类型特点,并探讨其较难定位的原因。方法回顾性分析2010年1月至2018年12月于福建医科大学附属第一医院神经外科经侵袭性颅内脑电图(iEEG)监测后行致痫灶切除的58例患者的临床资料,总结"难定位"难治性癫痫患者的临床病理类型特点及病变脑叶,根据Engel分级评估患者预后,使用单因素分析和多因素Logistic回归分析探讨影响皮质发育不良(MCD)相关"难定位"难治性癫痫的预后的相关因素。结果58例中,MCD 47例[轻微皮质发育不良(mMCD)12例,局灶性皮质发育不良(FCD)35例],其他11例;MCD中,通过单因素分析发现术前磁共振阳性、致痫灶完全切除的患者预后更佳(P<0.05),多因素分析发现致痫灶完全切除是影响MCD术后疗效的独立影响因素(P=0.013,Waldχ2=6.149,95%CI 0.07~0.56);MCD中,18例为单脑叶病变,29例为多脑叶病变,两组在疗效上的差异无统计学意义(P=0.511)。结论MCD尤其是FCD是"难定位"难治性癫痫的主要病理类型;多脑叶病理改变尤其是多脑叶MCD是导致"难定位"难治性癫痫较难定位致痫灶的主要原因,而通过有效使用iEEG精确定位致痫灶及功能区可使多数该类患者在致痫灶切除术后获得满意疗效。Objective To summarize the clinicopathological characteristics of "difficult to locate" intractable epilepsy patients, and investigate the causes of difficulty in their location.Method Retrospective analysis was performed on the clinical data of 58 patients who underwent resection of the epileptogenic zones after intracranial electroencephalography (iEEG) detection at the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2010 to December 2018. Clinicopathological characteristics and lesion lobes of "difficult to locate" intractable epilepsy were summarized. The prognosis of patients was assessed according to Engel grading.Univariate and multivariate logistic regression analysis were used to investigate the relevant factors affecting the prognosis of patients with "difficult to locate" intractable epilepsy related to malformation of cortical development(MCD).Results Among the 58 patients, there were 47 cases of MCD (12 cases with mild malformation of cortical development (mMCD), 35 cases with focal cortical dysplasia (FCD)), and 11 cases of other types. Among the 47 MCD cases, univariate analysis showed that patients with preoperative magnetic resonance imaging(MRI) positive and completed resection of the epileptogenic zones had better prognosis (P<0.05). Multivariate analysis indicated that completed resection of epileptogenic zones was an independent factor affecting the postoperative efficacy of MCD (P=0.013,Wald χ2=6.149, 95%CI: 0.07-0.56). And among the 47 MCD cases, 18 cases were with mono-lobar lesions and 29 cases were with multi-lobar lesions, however, there was no significant difference of the efficacy between the two groups (P=0.511).Conclusions MCD, especially FCD, is the main pathological types of patients with "difficult to locate" intractable epilepsy. Multi-lobar pathological changes, especially multi-lobar MCD, are the main reasons of being difficult to locate, however, accurate locating of epileptogenic zones and functional areas via effective

关 键 词：癫痫 大脑皮质 颅内脑电图 致痫灶 皮质发育不良 

分 类 号：R742.1[医药卫生—神经病学与精神病学]