发作间期头皮脑电图在手术治疗局灶性皮质发育不良Ⅱ型药物难治性癫痫中的作用  

The role of interictal scalp electroencephalography in the surgical treatment of intractable epilepsy caused by focal cortical dysplasia type Ⅱ

作　　者：杨晓丽 桑林[1] 郑重[1] 周峰[1] Yang Xiaoli;Sang Lin;Zheng Zhong;Zhou Feng(Department of Neurosurgery,Beijing Fengtai Hospital,Beijing 100070,China)

机构地区：[1]北京丰台医院神经外科,北京100070

出　　处：《中华神经外科杂志》2023年第5期495-499,共5页Chinese Journal of Neurosurgery

基　　金：北京市丰台区卫生健康系统科研项目(2020-41)。

摘　　要：目的 探讨发作间期头皮脑电图在手术治疗局灶性皮质发育不良(FCD)Ⅱ型药物难治性癫痫中的作用.方法 回顾性分析2015年4月至2019年12月北京丰台医院神经外科采用手术治疗、术后经病理学证实为FCDⅡ型的药物难治性癫痫患者的临床资料,共96例.对比分析术前头皮脑电图发作间期放电(IEDs)与发作期放电(IDs)分布定位病灶的准确性,以及对术后疗效(Engel分级)的预测作用.结果96例患者中,77例(80.2%)患者的IEDs表现为局灶/脑区性分布,IEDs分布区域均与手术切除脑区一致;非局灶/脑区性分布19例(19.8%).IEDs对手术切除病灶判断的准确率为80.2%(77/96).73例(76.0%)患者的IDs表现为局灶/脑区性分布,其中1例患者的IDs分布区域与手术切除脑区不一致;非局灶/脑区性分布23例(24.0%).IDs对手术切除病灶判断的准确率为75.0%(72/96).IEDs与IDs对手术切除病灶判断的准确率差异有统计学意义(P<0.001).96例患者术后中位随访时间为55.5个月(26~77个月).Engel Ⅰ级86例(89.6%),EngelⅡ~N级10例(10.4%).Engel Ⅰ级组中,73例(84.9%)术前头皮脑电图IEDs表现为局灶/脑区性,13例(15.1%)表现为非局灶/脑区性IEDs;Engel Ⅱ~Ⅳ级组中,4例(4/10)IEDs表现为局灶/脑区性,6例(6/10)表现为非局灶/脑区性,两组比较差异有统计学意义(P=0.003).Engel Ⅰ级组与Engel Ⅱ~Ⅳ级组比较,IDs分布差异无统计学意义(P=0.387).结论 术前头皮脑电图IEDs分布特征对FCD Ⅱ型药物难治性癫痫患者手术病灶定位的准确率较高,对术后疗效有预测作用.Objective To identify the role of interictal scalp electroencephalography(EEG)in the surgical treatment of intractable epilepsy caused by focal cortical dysplasia(FCD)type II.Methods A retrospective study was conducted on the clinical data of 96 patients with intractable epilepsy caused by FCD type II confirmed by postoperative pathology in the Department of Neurosurgery Beijing Fengtai Hospital from April 2015 to December 2019.We compared and analyzed the accuracy of preoperative scalp EEG interictal discharges(IEDs)and ictal discharges(IDs)in locating epileptogenic zones,as well as their predictive effects on postoperative outcomes.ResultsOf the 96 patients,77(80.2%)showed focal/regional distribution of IEDs,which was consistent with the area of surgical resection,and the accurate localization of the area of resection was 80.2%(77/96);19(19.8%)showed non-focal/regional distribution.Of the 96 patients,73(76.0%)showed focal/regional distribution of IDs,23(24.0%)showed non-focal/regional distribution,and the accuracy of IDs for localizing was 75.0%(72/96),as the focal/regional distribution of IDs was not consistent with the area of surgical resection in 1 patient.There was significant difference between IEDs and IDs in the localization accuracy of FCD I lesions(P<0.001).The 96 patients were followed up for 26-77(M:55.5)months.Engel class I was reported in 86 patients(89.6%)and class II-IV in 10 patients(10.4%).In Engel class I group,73 patients class II-IV group,4 patients(4/10)showed focal/regional IEDs,and 6 patients(6/10)showed non-focal/regional IEDs.There was significant difference in the distribution of IEDs between the two groups(P=0.003).However,there was no significant difference in the distribution of IDs between the two groups(P=0.387).Conclusion The distribution of IEDs in the preoperative scalp EEG has a higher accuracy in locating surgical lesions in patients with FCD type II drug-refractory epilepsy,and can predict the postoperative efficacy.

关 键 词：癫痫 脑电描记术 神经外科手术 局灶性皮质发育不良Ⅱ型 发作间期放电 

分 类 号：R742.1[医药卫生—神经病学与精神病学]