基于立体定向脑电图的电刺激在难治性癫痫评估中的临床应用进展  

Advances in clinical application of stereoelectroencephalography-based electrical stimulation in the evaluation of refractory epilepsy

作　　者：陈文静[1] 张月 赖大坤[2] 李真林[1] CHEN Wenjing;ZHANG Yue;LAI Dakun;LI Zhenlin(Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;School of Electronic Science and Engineering,University of Electronic Science and Technology of China,Chengdu,Sichuan 611731,P.R.China)

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]电子科技大学电子科学与工程学院,成都611731

出　　处：《华西医学》2023年第5期645-652,共8页West China Medical Journal

基　　金：国家重点研发计划(2022YFC2009905);四川省科学技术厅重点研发项目(2023YFG0126)。

摘　　要：临床上对于需手术治疗的难治性癫痫,术前精确定位致痫灶是提高临床手术治疗成功率的关键。目前尽管采用电刺激方式定位致痫灶已经在国内外多个医学中心广泛开展,但对于颅内立体定向脑电图(stereoelectroencephalography,SEEG)的术前植入评估及电刺激诱发脑电活动的解读仍不够完善和严谨,尤其是电极植入模式、刺激参数设计以及手术预后相关性等方面仍存在诸多局限性和未知领域。该文围绕基于SEEG的立体电刺激诱发脑电活动在评估难治性癫痫领域中的临床背景、应用现状、技术进展及发展趋势进行了综述,着重阐述了该技术在临床致痫灶定位和大脑皮质功能评价2个方面的应用现状,以及电刺激过程中的安全性及高频/低频两类常用电刺激模式的特点。For refractory epilepsy requiring surgical treatment in clinic,precise preoperative positioning of the epileptogenic zone is the key to improving the success rate of clinical surgical treatment.Although the use of electrical stimulation to locate epileptogenic zone has been widely carried out in many medical centers,the preoperative implantation evaluation of stereoelectroencephalography(SEEG)and the interpretation of electrical stimulation induced EEG activity are still not perfect and rigorous.Especially,there are still technological limitations and unknown areas regarding electrode implantation mode,stimulation parameters design,and surgical prognosis correlation.In this paper,the clinical background,application status,technical progress and development trend of SEEG-based stereo-electric stimulation-induced cerebral electrical activity in the evaluation of refractory epilepsy are reviewed,and applications of this technology in clinical epileptogenic zone localization and cerebral cortical function evaluation are emphatically discussed.Additionally,the safety during both of high-frequency and low-frequency electrical stimulations which are commonly used in clinical evaluation of refractory epilepsy are also discussed.

关 键 词：癫痫 致痫灶 立体定向脑电图 立体电刺激 大脑功能区评估 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]