大脑半球离断术后无癫痫发作的脑电图特征及其对停药选择的影响  

Seisure-free electroencephalogram characteristics after cerebral hemisphere dissociation surgery and their impact on drug withdrawal selection

作　　者：闫兆芬 王静[1] 康盼 邓琴琴 关宇光[2] 周健[1] 栾国明[1] YAN Zhaofen;WANG Jing;KANG Pan(Department of Neurology,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经内科,北京100093 [2]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《临床神经外科杂志》2023年第6期625-629,635,共6页Journal of Clinical Neurosurgery

基　　金：国家重点研发计划项目(2022YFC2503801)。

摘　　要：目的分析大脑半球离断术后无癫痫发作患者的脑电图(EEG)特征及其对停药的影响。方法回顾性分析2017年1月—2022年6月首都医科大学三博脑科医院收治的54例行半球离断术后均无癫痫发作的患者。收集术前术后临床资料及抗发作药物服药情况。结果术前EEG显示36例(66.7%)患者仅在手术侧半球记录到癫痫样放电,10例(18.5%)患者有双侧半球独立放电伴泛化,3例(5.6%)患者有双侧半球同步癫痫样放电;术后6~12个月EEG显示所有患者手术半球背景活动减弱,42例(77.8%)患者仅在手术半球有癫痫样放电,6例(11.1%)患者双侧半球均有癫痫样放电,3例(5.6%)患者放电位于手术半球及中线区,3例(5.6%)患者在两侧均无癫痫样放电,3例(5.6%)患者手术半球出现EEG发作但无临床症状。术后随访平均随访3年,14例患者(25.9%)停用抗发作药物后均无发作。结论大脑半球离断术对双侧半球癫痫样放电的患者仍可达到术后无发作。术后无临床发作但EEG显示存在癫痫样放电的患者可逐渐减停抗发作药物。Objective To analyze the electroencephalogram(EEG)characteristics of seizure-free patients after hemisphere dissociation surgery and their influence on drug withdrawal.Methods 54 patients who were admitted to Sanbo Brain Hospital,Capital Medical University,from January 2017 to June 2022,without epileptic seizures after hemisphere dissociation surgery.The preoperative and postoperative clinical data,as well as information on the use of antiepileptic drugs were collected.Results Preoperative EEG showed that 36 patients(66.7%)only recorded epileptic discharges in the operation side of hemisphere,10 patients(18.5%)had bilateral hemisphere independent discharges with generalization,and 3 patients(5.6%)had bilateral hemisphere synchronous epileptic discharges.After 6-12 months of surgery,the EEG showed a decrease in background activity in the operation side in all patients.42 cases(77.8%)had epileptic discharges only in the operation side,6 cases(11.1%)had epileptic discharges in both sides,3 cases(5.6%)had discharges located in the surgical side and midline area,3 cases(5.6%)had no epileptic discharges on both sides,and 3 cases(5.6%)had EEG seizures in the surgical side without clinical symptoms.The average postoperative follow-up was 3 years,and 14 patients(25.9%)had no seizure onset after discontinuing anti seizure drugs.Conclusions Hemisphere dissociation surgery can still achieve postoperative seizure free outcomes in patients with bilateral hemisphere epileptic discharges.Patients with no clinical seizure onset after surgery despite EEG epileptic discharge findings can gradually reduce the use of antiepileptic drugs.

关 键 词：大脑半球离断术 术后脑电图 癫痫样放电 

分 类 号：R651[医药卫生—外科学] R742.1[医药卫生—临床医学]