合并海马硬化的颞叶内侧型癫痫的网络分析  

Epilepsy network in mesial temporal lobe epilepsy with hippocampal sclerosis

作　　者：王垚[1] 王秀[1] 桑林[2] 刘畅[1] 郭志浩 张子卿 胡文瀚 张建国[1] 张凯[1] Wang Yao;Wang Xiu;Sang Lin(Department of neurosurgery,Beijing Tiantan Hospital,Capital Medical University,100050)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]北京丰台医院 [3]北京市神经外科研究所

出　　处：《立体定向和功能性神经外科杂志》2020年第2期65-68,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：国家自然科学基金项目(编号:81771399,81830033,81701276);北京市科学技术委员会,北京市科技计划项目(编号:Z171100001017069,Z161100000216130)。

摘　　要：目的在只有海马硬化为可见核磁共振病灶的颞叶内侧癫痫中,很多患者合并新皮质的局灶性皮质发育不良(FCD)。本文旨在探讨两者的癫痫网络差异。方法回顾性分析79例颞叶内侧型癫痫患者。所有患者行前颞叶切除术,术后随访至少1年无癫痫发作。根据病理将其分为单纯海马硬化组(HS)和合并新皮质FCD(FCD Ⅲa)组。将每个病人的术前发作间期18FDG-PET数据标准化后,利用Matlab下的SPM(statistical parametric mapping)工具包分析两组间的代谢差异。结果 FCD Ⅲa组和HS组,无论是左侧还是右侧,其发病年龄、病史、性别以及发作期的主要症状学出现的频率均无明显差异。而FCD Ⅲa组的癫痫网络明显大于HS组,有差异的脑区主要在颞叶新皮质、额叶内侧面,缘上回和中央前后回。结论 FCD Ⅲa的癫痫网络要比单纯海马硬化所致的颞叶癫痫范围要大而且更复杂。遇到海马硬化所致的颞叶癫痫,要充分考虑到FCD Ⅲa的可能性,必要时行立体脑电明确新皮质的切除范围。Objective In mesial temporal lobe epilepsy,neocortical focal cortical dysplasia(FCD) are common seen even if the hippocampal sclerosis is the only positive MRI change.The purpose of this paper is to explore epilepsy networks in the patients with and without neocortical FCD.Methods A total of 79 cases of mesial temporal lobe epilepsy were analyzed retrospectively.All patients underwent anterior temporal lobectomy and were seizure free after at least one-year follow-up.According to the pathology,they were divided into hippocampal sclerosis(HS) group and neocortex FCD(FCD Ⅲa) group.After standardizing interictal 18FDG-PET data of each patient before operation,the metabolism difference between the two groups was analyzed by SPM(statistical parameter mapping) toolkit under Matlab.Results There was no significant difference in age,history,gender and frequency of main semiology between FCD Ⅲa group and HS group.However,the epilepsy network of FCD Ⅲa group was significantly larger than that of HS group.The different brain areas were mainly in neocortex of temporal lobe,cingulate gyrus,supramarginal gyrus,precentral and postcentral gyrus.Conclusion The epilepsy network of FCD Ⅲa is larger and more complex than that of temporal lobe epilepsy caused by hippocampal sclerosis.In the case of temporal lobe epilepsy,the possibility of FCD Ⅲa should be fully considered,and if necessary,the resection range of neocortex should be determined by stereo-EEG.

关 键 词：颞叶癫痫 FCDⅢa 海马硬化 PET 癫痫网络 

分 类 号：R742.1[医药卫生—神经病学与精神病学]