枕叶癫痫患者的视觉症状分析  

Visual analysis of patients with occipital lobe epilepsy

作　　者：曹咪 魏子涵 刘超 乔晓枝 邓艳春 CAO Mi;WEI Zihan;LIU Chao(Department of Neurology,Xijing Hospital of Air Force Military Medical University,Xi’an(710032),Shanxi China)

机构地区：[1]空军军医大学第一附属医院(西京医院)神经内科,陕西西安710032 [2]西安医学院研究生处

出　　处：《癫痫与神经电生理学杂志》2021年第2期87-91,共5页Journal of Epileptology and Electroneurophysiology(China)

基　　金：科技部国家重点研发计划精准医学研究-神经系统疾病专病队列癫痫临床队列研究资助项目(NO:2017YFC0907702)。

摘　　要：目的枕叶癫痫的特征表现视觉症状不易被察觉,进行视觉症状分析,提高对枕叶癫痫症状学的认识,减少误诊、漏诊。方法选择2017年6月至2019年12月就诊于空军军医大学西京医院癫痫专科门诊确诊为枕叶癫痫的患者128例,选取其中有视觉症状表现的59例患者进行视觉症状、病因学、脑电图、治疗及预后分析。结果59例枕叶癫痫患者的视觉症状主要包括视幻觉16例(27%)、视盲29例(49%)、视错觉20例(34%);头颅影像学检查57例,32例(56%)未见异常,25例(44%)影像学有病灶,其中双顶枕叶脑软化灶并局部脑萎缩5例,脑白质异常6例,枕叶软化灶3例,钙化灶1例,海马肿胀或萎缩4例,双侧枕叶部分脑实质萎缩并胶质增生1例,PET示左侧顶枕交界区葡萄糖代谢减低1例,其他4例。长程视频脑电图监测59例患者在发作间期均有痫样放电,其中局限于枕叶异常放电21例(18%),枕叶、颞叶异常放电45例(38%),枕叶、顶颞叶异常放电21例(18%),枕叶、额颞叶异常放电13例(11%),一侧性异常放电8例(7%),广泛性异常放电10例(8%)。在波形统计中尖慢波45例(37%),占比最高,其次为尖波37例(30%)、棘慢波17例(13%)、棘波13例(11%)。治疗上使用单药治疗33例(56%),以奥卡西平、左乙拉西坦应用最多;使用抗癫痫药物≥2种有24例(41%),联合治疗以奥卡西平联合左乙拉西坦最常见。随访1年无发作达22例(37%),显效21例(36%)。结论枕叶癫痫的视觉症状各异,常见的有视盲(视物模糊、黑朦)、视错觉(视物变形、旋转、重影)、视幻觉(视物发花、闪光感)。视觉症状的识别对枕叶癫痫有重要的诊断价值。Objective To analyze the visual symptoms,which is difficult to detect and improve the understanding of symptomatology of occipital lobe epilepsy(OLE)and reduce misdiagnosis and missed diagnosis.Methods From June 2017 to December 2019,128 patients with OLE diagnosed in the Epilepsy Clinic of Xijing Hospital of Air Force Military Medical University China were collected,Out of them,59 cases with visual symptoms were selected for the detection of visual symptoms,etiology and EEG,and for the analysis of prognosis and treatment of OLE.Results The visual symptoms of 59 patients with OLE mainly included visual hallucination in 16 cases(27.12%),visual blindness in 29 cases(49.15%),and visual illusion in 20 cases(33.90%).According to the imaging examination of 57 cases,32 cases(56.14%)were normal,25 cases(43.86%)EEG images have lesions,including double pillow parietal lobe encephalomalacia foci and regional cerebral atrophy in 5 cases,cerebral white matter abnormalities in 6 cases,occipital lobe softening oven in 3 cases,calcifications in 1 case,hippocampus atrophy or welling in 4 cases,bilateral occipital part parenchymal atrophy and gliosis in 1 case,PET showed that metabolism was reduced on the left side of the pillow top border area in 1 case,and other symptoms in 4 cases.Long term video EEG showed that all the 59 cases had epileptiform discharges during interictal period,including 21 cases(17.80%)confined in occipital lobe,45 cases(38.14%)in occipital and temporal lobes,21 cases(17.80%)in occipital and parietal temporal lobes,13 cases(11.02%)in occipital and front otemporal lobes,8 cases(6.78%)with unilateral abnormal discharges,and 10 cases(8.47%)with generalization abnormal discharges.According to waveform statistics,there were 45 cases(36.89%)with sharp slow waves,accounting for the highest proportion,followed by 37 cases(30.33%)with sharp waves,17 cases(13.39%)with spike slow waves and 13 cases(10.66%)with spike waves.33 cases(55.93%)were treated with single drug,(OXC or LEV was most commonly used).24 cases(40.68%

关 键 词：枕叶癫痫 视觉症状 病因 脑电图 预后 

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]