SEEG高频振荡分析在癫痫射频热凝损毁术治疗中的临床应用  

High-frequency oscillations analysis in stereotactic electroencephalogram guided radiofrequency thermocoagulation in treating refractory epilepsy

作　　者：屈直闯 陈欣 罗娟 张元元 余思逊 树海峰 Qu Zhichuang;Chen Xin;Luo Juan;Zhang Yuanyuan;Yu Sixun;Shu Haifeng(Department of Neurosurgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Neurosurgery,PLA Western Theater Command General Hospital,Chengdu 610083,China)

机构地区：[1]西南医科大学附属医院神经外科,泸州646000 [2]解放军西部战区总医院神经外科,成都610083

出　　处：《中华神经医学杂志》2023年第6期585-591,共7页Chinese Journal of Neuromedicine

基　　金：四川省科技厅科技创新人才项目(22CXRC0178);军事医学创新工程专项(21WQ040);西南交大医工结合培育专项(重点项目)(2682021ZTPY024);西部战区总医院院管课题(2021-XZYG-B22、2021XZYG-B21、2019LH01)。

摘　　要：目的探究立体定向脑电图(SEEG)高频振荡(HFOs)分析在射频热凝损毁术(RF-TC)治疗难治性癫痫患者中的临床应用价值。方法选择解放军西部战区总医院神经外科自2019年8月至2021年12月采用SEEG引导下RF-TC治疗的14例难治性癫痫患者,运用Matlab软件的自动检测算法计算SEEG各导联HFOs发生频率,利用HFOs发生频率生成非线性拟合曲线,根据拟合曲线制定HFOs阈值并划分HFOs区域(涟波区域、快涟波区域)。术后3、6个月根据有无癫痫发作将患者分为无癫痫发作组和有癫痫发作组,末次随访时根据Engel分级评估患者的预后并将患者分为预后良好组和预后不良组,比较2组患者涟波热凝率、快涟波热凝率的差异。结果14例患者的SEEG监测数据中,共检测到7332个涟波,1144个快涟波。术后6个月内患者神经功能障碍发生率为14.3%,永久神经功能障碍、颅内感染、颅内出血、电极设备故障等情况均未发生。术后3个月患者的无癫痫发作率为71.4%(10/14),无癫痫发作组患者的快涟波热凝率显著高于有癫痫发作组患者,差异有统计学意义(P<0.05);术后6个月患者的无癫痫发作率为57.1%(8/14),无癫痫发作组患者的涟波热凝率显著高于有癫痫发作组患者,差异有统计学意义(P<0.05);末次随访时患者预后良好6例,预后不良8例。预后良好组患者的涟波热凝率高于预后不良组患者,差异有统计学意义(P<0.05)。结论HFOs分析可以辅助定位致痫区。对涟波或快涟波区域热凝范围较大患者的短期疗效较好,对涟波区域热凝范围较大患者的预后较好。Objective To explore the clinical application values of radiofrequency thermocoagulation(RF-TC)based on stereotactic electroencephalogram(SEEG)high-frequency oscillations(HFOs)analysis in patients with refractory epilepsy.Methods Fourteen patients with refractory epilepsy treated with SEEG-guided RF-TC were selected from Department of Neurosurgery,PLA Western Theater Command General Hospital from August 2019 to December 2021.Automatic detection algorithm of Matlab was used to calculate the HFOs incidence in each montage,and the fitting curves of HFOs incidences were used to formulate the threshold of HFOs and delimit the HFOs regions(ripples and fast ripples).These patients were divided into non-seizure group and seizure group according to the prognoses 3 and 6 months after RF-TC.At the last follow-up,these patients were divided into good prognosis group and poor prognosis group according to Engel grading;the differences of ripple thermocoagulation rate and fast ripple thermocoagulation rate between the 2 groups were compared.Results A total of 7,332 ripples and 1,144 fast ripples were detected in SEEG data from 14 patients.Six months after surgery,neurological dysfunction incidence was 14.3%,without permanent neurological dysfunction,intracranial infection,intracranial hemorrhage,or electrode equipment failure.Within 3 months of RF-TC,seizure-free rate was 71.4%(10/14),and fast ripple thermocoagulation rate in non-seizure group was significantly higher than that in seizure group(P<0.05);within 6 months of RF-TC,seizure-free rate was 57.1%(8/14),and ripple thermocoagulation rate in non-seizure group was significantly higher than that in seizure group(P<0.05).At last follow-up,6 patients had good prognosis and 8 patients had poor prognosis;the ripple thermocoagulation rate in good prognosis group was significantly higher than that in poor prognosis(P<0.05).Conclusions HFOs can assist in designating epileptogenic regions.Patients with wider range of thermocoagulation ripples or fast ripples will have better short-t

关 键 词：难治性癫痫 立体定向脑电图 高频振荡 射频热凝损毁术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]