药物难治性癫痫性痉挛发作的立体脑电图特点  

The characteristics of stereoelectroencephalography in drug-resistant epileptic spasms

作　　者：张冰清[1] 王海祥[1] 丰倩[1] 史洁[1] 林久銮[1] 宋宪成[1] 周文静[1] Zhang Bingqing;Wang Haixiang;Feng Qian;Shi Jie;Lin Jiuluan;Song Xiancheng;Zhou Wenjing(Department of Neurosurgery Ward 3,Tsinghua University Yuquan Hospital,Beijing 100040,China)

机构地区：[1]清华大学玉泉医院神经外科三病区,北京100040

出　　处：《中华实用儿科临床杂志》2023年第8期571-574,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的:研究药物难治性癫痫性痉挛(ES)发作的立体脑电图(SEEG)特点,探讨经SEEG引导下痉挛发作患儿的手术策略。方法:回顾性分析2014年1月至2021年12月在清华大学玉泉医院神经外科三病区进行术前评估的ES发作患儿(156例)临床资料,患儿在非侵袭性术前评估后均进行立体定向电极置入二期评估。分析患儿的颅内脑电图特点、手术策略及预后。结果:共19例患儿符合入组标准,其中男13例,女6例;首次发作年龄1个月至4岁,手术年龄2~13岁。痉挛发作时SEEG分为3型:SEEG发作A型5例,表现为局灶性发作起始演变为成串广泛快波节律;SEEG发作B型10例,表现为局灶性棘波或快波提前出现(即局灶性"前导性棘波")快速泛化为弥漫性快波节律;SEEG发作C型4例,表现为弥漫性快波节律起始,虽可见某些电极放电略提前出现,但范围超过一个脑区。19例患儿经局灶性切除术或热凝后13例无发作,其中SEEG发作A型5例,SEEG发作B型8例。SEEG发作A型和B型患儿SEEG发作间歇期可见与发作起始于一致的局灶性癫痫样放电显著现象,手术切除这些部位可有效控制痉挛发作。结论:ES发作可能因局灶性新皮质放电点燃,颅内脑电图发现局灶性发作起源演变为痉挛发作或局灶性"前导性棘波"是手术预后好的一个指标。ObjectiveTo analyze the characteristics of stereoelectroencephalography(SEEG)in children with drug-resistant epileptic spasms(ES),and to explore the surgical strategy of children with spastic seizure under the guidance of SEEG.MethodsThe clinical data of 156 children with ES who were preoperatively evaluated in the Department of Neurosurgery Ward 3,Tsinghua University Yuquan Hospital from January 2014 to December 2021 were retrospectively reviewed.All children were evaluated in the second stage of stereotactic electrode placement after a non-invasive preoperative evaluation.The characteristics of intracranial EEG,surgical strategy and prognosis were analyzed.ResultsA total of 19 eligible children were included,involving 13 boys and 6 girls.The age of first onset and surgical age of them ranged 1 month to 4 years,and 2 years to 13 years,respectively.The SEEG was divided into 3 types in children with ES at the onset.Five children were SEEG type A,presenting with the focal seizure discharges at the beginning and a gradual propagation to widespread fast-wave bursts.Ten children were SEEG type B,presenting a focal leading spike followed by diffused fast-wave bursts.Four children were SEEG type C,presenting a diffuse fast wave rhythm onset.Although some electrode discharges appeared slightly"leading",they covered more than one brain region.After focal resection or thermocoagulation,13/19 patients did not have the onset of seizures,and 5/19 and 8/19 were graded as SEEG type A,and B,respectively.During the intermittent period of SEEG attacks in children with SEEG type A and B,a significant phenomenon of focal epileptic discharge consistent with the onset of the attack was observed,and surgical removal of these areas effectively controlled spastic seizures.ConclusionsEpileptic spasms may be triggered by a focal neocortical discharge.Intracranial EEG showed that the focal seizure onset evolves into spasm or a focal"leading spike"is a good indicator of surgical prognosis.

关 键 词：难治性癫痫 癫痫性痉挛 立体脑电图 癫痫外科 

分 类 号：R742.1[医药卫生—神经病学与精神病学]