药物难治性癫痫患者杏仁核电刺激的功能反应及其在致痫灶定位中的作用  

Functional response of electrical stimulation of the amygdala in drug-refractory epilepsy patients and its role in the localization of epileptogenic zone

作　　者：高颖 周晓霞[1] 张晓华[1] 遇涛[1] Gao Ying;Zhou Xiaoxia;Zhang Xiaohua;Yu Tao(Department of Functional Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing Institute of Functional Neurosurgery,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院功能神经外科,北京功能神经外科研究所,北京100053

出　　处：《中华神经外科杂志》2024年第2期126-131,共6页Chinese Journal of Neurosurgery

基　　金：科技创新2030——“脑科学与类脑研究”重大项目(2021ZD0201605);国家自然科学基金(82271494);北京市教委-市自然基金委联合资助项目(KZ202110025036)。

摘　　要：目的 通过分析药物难治性癫痫患者杏仁核电刺激后产生的症状,探讨杏仁核的生理学功能及其在致痫灶定位中的作用.方法 回顾性分析2017年1月至2023年4月于首都医科大学宣武医院功能神经外科行杏仁核立体脑电图(SEEG)电极置入的49例药物难治性癫痫患者的电刺激相关资料.按照受试者报告和临床观察分类统计电刺激杏仁核产生的临床症状,对刺激出先兆症状患者的致痫区进行统计分析.结果 49例患者中,杏仁核内置入电极55根,杏仁核内的触点192个.电刺激后44例患者产生174例次临床症状,其中情绪反应40例次(23.0%)、植物神经症状52例次(29.9%)、躯体感觉症状33例次(19.0%)、头部感觉症状32例次(18.4%)、视觉症状10例次(5.7%)、嗅觉症状3例次(1.7%)、运动症状4例次(2.3%).44例患者的174例次临床症状中,22例(50.0%)患者的82例次(47.1%)临床症状为先兆症状.82例次的先兆症状中,39例次(47.6%,9例)的发作起始区为杏仁核和海马,9例次(11.0%,1例)为杏仁核,17例次(20.7%,7例)为海马,13例次(15.9%,3例)为额叶,4例次(4.9%,2例)为岛叶.结论 电刺激药物难治性癫痫患者的杏仁核可以诱发多种功能反应,部分可能为杏仁核自身激活的反应,部分可能为癫痫发作的先兆症状.提示杏仁核参与机体多项生理功能,并在癫痫发作网络中起到关键节点的作用.ObjectiveTo explore the physiological function of the amygdala and its role in the localization of epileptogenic zone(EZ)by analyzing the symptoms produced by electrical stimulation of the amygdala in drug-refractory epilepsy patients.MethodsA retrospective analysis was conducted on the electrical stimulation data of 49 drug-refractory epilepsy patients who underwent stereoelectroencephalography(SEEG)electrode implantation at the Department of Functional Neurosurgery,Xuanwu Hospital,Capital Medical University from January 2017 to April 2023.According to the subject report and clinical observation of the clinical symptoms produced by the electrical stimulation of the amygdala,statistical analysis was conducted on the EZ of epilepsy patients in whom electrical stimulation induced the aura of seizures.ResultsAmong 49 patients,a total of 55 SEEG electrodes were implanted in the amygdala,with 192 contacts located in the amygdala.After electrostatic stimuli,44 patients developed a total of 174 clinical symptoms,including 40(23.0%)cases of emotional reactions,52(29.9%)cases of vegetative symptoms,33(19.0%)cases of somatic sensations,32(18.4%)cases of head sensations,10(5.7%)cases of visual symptoms,3(1.7%)cases of olfactory symptoms and 4(2.3%)cases of motion symptoms.Of the 174 clinical symptoms of 44 patients,the clinical symptoms of 82(47.1%)procedures of stimulations in 22(50.0%)patients were auras.The EZ was located in the amygdala and hippocampus in 39 procedures(47.6%,9 patients),the amygdala in 9 procedures(11.0%,1 patient),the hippocampus in 17 procedures(20.7%,7 patients),the frontal lobe in 13 procedures(15.9%,3 patients)and the insula lobe in 4 procedures(4.9%,2 patients).ConclusionsElectrical stimulation of the amygdala in drug-refractory epilepsy patients can induce a variety of functional reactions.Some may be the reaction of the amygdala itself,and some may be the aura of epileptic seizures.It suggests that the amygdala participates in a number of physiological functions of the body and play a role in ke

关 键 词：耐药性癫痫 杏仁核 电刺激 神经病学表现 

分 类 号：R651.1[医药卫生—外科学]