难治性局灶性癫痫的多学科团队模式诊疗策略  

Diagnosis and treatment strategy for refractory focal epilepsy in multidisciplinary model

作　　者：蔡旸 罗荣奎 胡凡 林江 石洪成 纪元 丁晶 汪昕 CAI Yang;LUO Rong-kui;HU Fan;LIN Jiang;SHI Hong-cheng;JI Yuan;DING Jing;WANG Xin(Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China)

机构地区：[1]复旦大学附属中山医院神经内科,上海200032 [2]复旦大学附属中山医院病理科,上海200032 [3]复旦大学附属中山医院神经外科,上海200032 [4]复旦大学附属中山医院放射诊断科,上海200032 [5]复旦大学附属中山医院核医学科,上海200032

出　　处：《中国临床医学》2021年第2期299-304,共6页Chinese Journal of Clinical Medicine

基　　金：上海市卫生健康委员会优秀学科带头人项目(2018BR05).

摘　　要：目的:探讨难治性局灶性癫痫的多学科团队模式(multidisciplinary team,MDT)诊疗策略。方法:介绍1例药物难治性颞叶癫痫,头皮脑电图监测示患者双侧颞区不同步放电,常规磁共振序列扫描未见明显异常,初步评估为患者病灶位置和侧向性不明。进行MDT讨论和后续进一步术前评估,明确患者致痫灶和治疗方法。结果:患者为右内侧颞叶癫痫,接受右侧前颞叶+海马+杏仁核切除术,术后病理示致痫灶为节细胞胶质瘤合并局灶性皮质发育不良(局灶性皮质发育不良Ⅲb型)。术后1年余患者无癫痫发作。结论:MDT模式有助于进一步明确难治性局灶性癫痫患者的致痫灶部位,为患者的进一步手术治疗提供精准定位和手术切除范围参考,促使患者术后达到无发作状态。Objective:To explore the diagnosis and treatment strategy of multidisciplinary team(MDT)for refractory focal epilepsy.Methods:The patient was diagnosed with intractable temporal lobe epilepsy.The interictal scalp electroencephalogram showed unsynchronized epileptiform discharges on bilateral temporal lobes.The conventional magnetic resonance imaging was normal with no obvious lesions.Then the epileptogenic focus and treatment method were comfirmed by MDT diagnosis and presurgical evaluation.Results:The patient was diagnosed with right medial temporal lobe epilepsy after detailed preoperative assessment,and was further operated on the anterior right temporal lobe,hippocampus,and amygdaloid nucleus.The postoperative pathology revealed the ganglioglioma with the focal cortical dysplasia in surrounding tissues.There was no seizure more than one year after operation.Conclusions:The MDT system could help to precisely localize the epileptogenic focus and provide a foundation for the surgical resection range.The MDT diagnosis and treatment could help the patient to reach postoperatively seizure-free.

关 键 词：难治性癫痫 磁共振 正电子发射型计算机断层显像 立体定向脑电图 多学科团队 

分 类 号：R742.1[医药卫生—神经病学与精神病学]