立体定向脑电图引导下射频热凝消融治疗结节性硬化相关癫痫的研究  

SEEG-guided radiofrequency thermocoagulation ablation for tuberous sclerosis.associated epilepsy

作　　者：张冰清[1] 王海祥[1] 丰倩[1] 贺晶[1] 林久銮[1] 柏建军[1] 周文静[1] ZHANG Bingqing;WANG Haixiang;FENG Qian;HE Jing;LIN Jiuluan;BAI Jianjun;ZHOU Wenjing(Department of Neurosurgery Ward 3,Tsinghua University Yu-Quan Hospital,Beijing 100040,China)

机构地区：[1]清华大学玉泉医院(清华大学中西医结合医院)神经外科三病区,北京100040

出　　处：《癫痫杂志》2024年第3期221-227,共7页Journal of Epilepsy

基　　金：国家自然科学基金(31771255)。

摘　　要：目的 研究立体定向脑电图(Stereoelectroencephalography,SEEG)引导下射频热凝消融(Radiofrequency thermocoagulation,RF-TC)治疗结节性硬化(Tuberous sclerosis complex,TSC)相关癫痫的治疗效果,并探讨SEEG引导下RF-TC的治疗反应对后续手术治疗效果的预测。方法 回顾性分析2014年1月—2023年1月于清华大学玉泉医院神经外科进行SEEG二期评估的TSC患者,选择SEEG监测完成后进行了RFTC的患者,研究RF-TC后患者的发作控制情况,根据RF-TC治疗结果将患者分为RF-TC治疗有效组和无效组,比较两组患者SEEG后外科手术效果,来探讨RF-TC治疗对手术效果的预测。结果 59例TSC患者入组,53例(89.83%)患者进行了基因筛查,其中TSC1阳性28例(52.83%)、TSC2阳性21例(39.62%)、阴性4例(7.54%),其中新生突变33例(67.34%)。SEEG电极置入侧别:9例左侧半球置入、13例右侧半球置入、37例双侧半球置入。RF-TC后3个月无发作37例(62.71%)、6个月无发作31例(52.54%)、12个月无发作29例(49.15%)、24月以上无发作20例(39.21%)。11例患者在RF-TC后发作减少75%以上,余11例患者在RF-TC后发作变化不明显。RF-TC有效组48例(81.35%)、无效组11例(18.65%)。22例RF-TC有效组患者在局灶性切除后激光消融后19例无发作(86.36%)。10例无效组患者在局灶性切除或激光消融后5例无发作(50%),两组间差异具有统计学意义(P<0.05)。结论 研究显示SEEG引导下RF-TC对TSC相关癫痫是一种安全且有效的兼具诊断和治疗的诊疗手段,可以辅助指导未来切除性手术策略的制定并判断预后。Objective To study the therapeutic efficacy of stereoelectroencephalography(SEEG)-guided radiofrequency thermo-coagulation ablation(RF-TC)in the treatment of tuberous sclerosis(TSC)related epilepsy and to investigate the prediction of the therapeutic response to SEEG-guided RF-TC for the efficacy of the subsequent surgical treatment.Methods We retrospectively analyze TSC patients who underwent SEEG phase II evaluation from January 2014 to January 2023,and to select patients who underwent RF-TC after completion of SEEG monitoring,study the seizure control of patients after RF-TC,and classify patients into effective and ineffective groups for RF-TC treatment according to the results of RF-TC treatment,compare the surgical outcomes of patients in the two groups after SEEG,to explore the prediction of surgical outcome by RF-TC treatment.Results 59 patients with TSC were enrolled,53 patients(89.83%)were genetic detection,of which 28(52.83%)were TSC1-positive,21(39.62%)were TSC2-positive,and 4(7.54%)were negative,with 33(67.34%)de novo mutations.The side of the SEEG electrode placement:left hemisphere in 9 cases,right hemisphere in 13 cases,and bilateral hemisphere in 37 cases.37 patients(62.71%)were seizure-free at 3 months,31 patients(52.54%)were seizure-free at 6 months,29 patients(49.15%)were seizure-free at 12 months,and 20 patients(39.21%)were seizure-free at 24 months or more.11 patients had a seizure reduction of more than 75%after RF-TC,and the remaining ll patients showed no significant change after RF-TC.There were 48 patients(81.35%)in the effective group and 11 patients(18.65%)in the ineffective group.In the effective group,22 patients were performed focal tuber resection laser ablation,19 cases were seizure-free(86.36%).In the ineffective group,10 patients were performed focal tuber resection laser ablation,only 5 cases were seizure-free(50%),which was a significant difference between the two groups(P<0.05).Conclusions Our data suggest that SEEG guided RF-TC is a safe and effective both diagnostic and the

关 键 词：结节性硬化综合征 癫痫 立体定向脑电图 射频热凝消融术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R593.25[医药卫生—临床医学]