脑皮层电极监测对双重病理所致难治性癫痫临床疗效的初步分析  

Clinical effect of cortical electrode monitoring on intractable epilepsy caused by double pathology

作　　者：王中鸣 李广丽 彭琼[1,2] 黄亚辉 卢军[1,2] 谢琪 周桂云[1,2] WANG Zhongming;LI Guangli;PENG Qiong;HUANG Yahui;LU Jun;XIE Qi;ZHOU Guiyun(Epilepsy Center,Hunan Brain Hospital,Changsha 410073,China;Clinical School of Medicine,Hunan University of Chinese Medicine,Changsha 410073,China;Department of Rehabilitation Medicine,Hunan Brain Hospital Changsha 410073,China)

机构地区：[1]湖南省脑科医院癫痫中心,长沙410073 [2]湖南中医药大学临床医学院,长沙410073 [3]湖南省脑科医院康复医学科,长沙410073

出　　处：《癫痫杂志》2024年第2期104-107,共4页Journal of Epilepsy

基　　金：湖南省卫生健康委科研计划项目(B202303077762);湖南省自然科学基金(2023JJ60291)。

摘　　要：目的探讨脑皮层电极(Electro-Cortico-Graphy,ECoG)监测对双重病理所致难治性癫痫的临床疗效。方法回顾性分析2020年1月—2021年12月于湖南省脑科医院行手术治疗的10例术后病理检验证实为具有内侧颞叶硬化(Medial temporal lobe sclerosis,MTS)及局灶性皮层发育不良(Focal cortical dysplasia,FCD)双重病理的难治性癫痫患者,均口服药物效果较差,所有患者均经充分术前评估确定致痫灶切除范围,术中应用脑皮层电极对相应部位皮层脑电进行监测,确定痫性放电的部位及范围,行致痫灶切除、皮层热灼,再行皮层脑电监测用以调整切除策略。术后随访24~48个月,根据Engel分级评定患者预后。结果本组10例患者中,术后有1例患者出现急性硬膜下出血,1例患者出现语言及命名障碍,但出院时均得到恢复,其余患者未发现颅内感染、偏瘫、失语等神经功能缺损;术后发作控制EngelⅠ级占9例(占90%),EngelⅢ级1例(10%)。结论皮层电极监测对于双重病理征所致难治性癫痫安全、有效。Objective To investigate the clinical effect of Electro-Cortico-Graphy(ECOG)monitoring on refractory epilepsy caused by double pathology.Methods A retrospective analysis was performed on 10 patients with refractory epilepsy who underwent surgical treatment in Hunan Brain Hospital from January 2020 to December 2021.The diagnosis of postoperative disease was dual pathology of medial temporal lobe sclerosis(MTS)and focal cortical dysplasia(FCD),and the effect of oral drugs was poor.All patients underwent full preoperative evaluation to determine the scope of excision of epileptogenic lesions.Cortical electrodes were used to monitor the location and scope of epileptic discharge during the operation.Epileptogenic lesions were excised,cortical heat cautery was performed,and then cortical EEG monitoring was performed to adjust the excision strategy.The patients were followed up for 24 to 48 months,and the prognosis was assessed according to the Engel scale.Results Among the 10 patients,1 patient had acute subdural hemorrhage after surgery,1 patient had speech and naming disorders,but all of them were recovered at discharge.The other patients had no neurological defects such as intracranial infection,hemiplegia,aphasia,etc.Engel grade I was observed in 9 cases(90%)and Engel grade III was observed in 1 case(10%).Conclusion Cortical electrode monitoring is safe and effective for refractory epilepsy caused by double pathological signs.

关 键 词：皮层电极监测 双重病理征 难治性癫痫 手术治疗 

分 类 号：R742.1[医药卫生—神经病学与精神病学]