难治性顶叶癫痫患者的临床影像学与神经电生理特点分析  

Analysis of clinical imaging and neurophysiological characteristics in patients with intractable parietal lobe epilepsy

作　　者：张艳 崔玉真 李黎娜 商继峰 韩聪聪 陈富勇 肖海兵 李勇杰 ZHANG Yan;CUI Yuzhen;LI Lina(Neuromedicine center,the University of Hong Kong-Shenzhen Hospital,Shenzhen 518000,Guangdong,China)

机构地区：[1]香港大学深圳医院神经医学中心,广东深圳518000 [2]香港大学深圳医院癫痫中心,广东深圳518000

出　　处：《癫痫与神经电生理学杂志》2024年第1期1-8,共8页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的探讨难治性顶叶癫痫(PLE)患者的临床影像学与神经电生理特点。方法回顾性分析2021年1月至2023年2月在香港大学深圳医院癫痫中心接受术前评估及手术治疗的9例难治性PLE患者的病历资料,收集患者的人口学、临床症状、脑电图(EEG)、头颅核磁共振(MRI)、正电子发射型计算机断层显像(PET-CT)扫描结果及临床结局等信息,并进行系统分析。结果9例难治性PLE患者的男女比为5∶4,其中6例有失空间感、头晕等先兆症状,其最常见的首发症状分别是愣神和单侧肢体运动。发作间期EEG示,4例患者出现2种形式的放电,即局灶性放电和全导联广泛性尖/棘波/棘慢复合波。尖棘波放电最显著的部位最常出现在双颞区或单侧颞区电极有6例,其次是全导联广泛性棘慢波放电有4例,其后依次是单侧顶枕区、一侧半球等。发作期EEG示,8例为单侧颞叶或单侧顶叶起源,1例患者起源不明。5例MRI为阴性,2例为软化灶,1例为顶叶占位,1例为左侧缘上回皮层增厚。PET-CT结果显示7例为双侧或单侧顶区低代谢。8例行立体定向脑电图(SEEG)植入,1例行硬膜下电极植入。9例中有8例患者接受了热凝毁损术,其中3例患者接受了致痫灶切除,术后病理结果提示分别为中心性血管性胶质瘤、胚胎发育不良性神经上皮肿瘤及致痫灶。9例患者术后疗效均为EngelⅠ级。结论难治性PLE的症状学致痫灶定位特征弱,单纯依靠头皮EEG易误诊,需要结合头颅MRI、PET-CT、颅内EEG及MDT讨论来综合定位致痫灶。经过多学科合作、应用多项技术手段综合定位后,对难治性PLE患者实施手术疗效较好。Objective To analyze the clinical imaging and electrophysiological characteristics of patients with intractable parietal lobe epilepsy.Methods A retrospective analysis was conducted on clinical data of 9 patients with intractable parietal lobe epilepsy who underwent preoperative assessment and surgical treatment at the Epilepsy Center of the University of Hong Kong-Shenzhen Hospital from January 2021 to February 2023.The information was collected and systematically analyzed,including demographics,clinical symptoms,electroencephalography(EEG),cranial MRI,positron emission tomography--computed tomography(PET-CT)scan results,and clinical outcomes.Results The male-to-female ratio of 9 patients with intractable parietal lobe epilepsy was 5∶4.Among them,6 cases had premonitory symptoms such as loss of space and dizziness,with the most common initial symptoms being confusion and unilateral limb movement.Interictal EEG showed that there were 6 cases with bilateral or unilateral temporal discharge,4 cases with generalized spike-and-wave discharges across all leads.During ictal periods,EEG showed that 8 cases had unilateral temporal or parietal origin,while 1 patient had unknown origin.Among 9 cases,there were 5 cases with negative MRI,2 cases with malacia,1 case with parietal lobe occupancy,and 1 case with cortical thickening of the left marginal gyrus.PET-CT scan results showed that there were 7 cases with bilateral or unilateral parietal hypometabolism.Eight cases underwent stereoelectroencephalogram(SEEG)implantation,and 1 case underwent subdural electrode implantation.Among 9 cases,8 cases underwent thermal coagulation ablation therapy,and 3 cases underwent epileptogenic lesion resection.The postoperative pathological results showed central vascular glioma,embryonic dysplasia neuroepithelial tumor and epileptogenic lesion,respectively.Post-surgical outcomes for all nine patients were classified as Engel Class I.Conclusion The symptomatic localization characteristics of intractable parietal lobe epilepsy are weak,and

关 键 词：顶叶癫痫 发作症状 影像学 头皮脑电图 立体定向脑电图 神经电生理 

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