发作间期双侧颞区放电的颞叶癫痫患者脑电图特征及与术后疗效的关系  

Electroencephalographic characteristics of patients with temporal lobe epilepsy with bitemporal interictal epileptiform discharges and their association with surgical outcome

作　　者：马炜 陈隆 张伟 高立 MA Wei;CHEN Long;ZHANG Wei(Department of Neurosurgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院神经外科,陕西西安710038

出　　处：《中风与神经疾病杂志》2024年第6期525-528,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨发作间期有双侧颞区放电的颞叶癫痫(TLE)患者脑电图特征及与术后疗效的关系。方法回顾性分析2013年1月—2019年12月在空军军医大学唐都医院进行手术治疗的双侧颞区有发作间期癫痫样放电(IEDs)的TLE患者的临床资料,并比较不同发作间期及发作期患者间术后疗效的差异。结果共纳入159例TLE患者,IEDs频率无侧别优势占42.1%(67/159);手术侧优势占48.4%(77/159);对侧优势占9.4%(15/159)。73.0%(116/159)的患者捕获到临床发作,其中手术侧颞区起源占56.0%(65/116),同侧半球起源占5.2%(6/116),对侧颞区起源占5.2%(6/116)及不确定起源侧别占33.6%(39/116)。术后29例患者失随访,其余平均随访(64.0±20.6)个月(26~101个月),66.2%(86/130)的患者为EngelⅠ级,33.8%(44/130)为EngelⅡ~Ⅳ级,不同发作间期放电形式(P=0.794)和无发作期及不同发作期起源模式(P=0.299)的患者间疗效差异无统计学意义。结论伴有双侧颞区IEDs的TLE患者通过综合术前评估并采取手术治疗,可获得较好的长期控制疗效,不同特征的发作间期放电或发作期起源模式和术后疗效无关,发作期脑电图不是术前评估所必需。Objective To investigate the electroencephalographic characteristics of patients with temporal lobe epilepsy(TLE)with bitemporal interictal epileptiform discharges(IEDs)and their association with surgical outcome.Methods We retrospectively collected the clinical data of patients with TLE with IEDs who underwent surgical treatment at our epilepsy center from January 2013 to December 2019.The surgical outcomes of patients with different interictal and ictal electroencephalographic characteristics were compared.Results A total of 159 patients with TLE were included in this study.The frequency of IEDs showed no laterality in 42.1%(67/159)of the patients,dominance on the surgical side in 48.4%(77/159),and dominance on the contralateral side in 9.4%(15/159).Seizures were recorded in 73.0%(116/159)during preoperative electroencephalogram monitoring,which originated from the temporal lobe on the surgical side in 56.0%(65/116),the ipsilateral hemisphere in 5.2%(6/116),the contralateral temporal lobe in 5.2%(6/116),and on an undetermined side in 33.6%(39/116).Twenty-nine patients were lost to follow-up after surgery,and the remaining patients were followed up for a mean length of(64.0±20.6)months(26-101 months),with 66.2%(86/130)of them in Engel class I and 33.8%(44/130)in Engel class II-IV.There were no significant differences in surgical outcome between patients with different types of IEDs(P=0.794)and those with different seizure origins(P=0.299).Conclusion Patients with TLE with bitemporal IEDs can achieve effective control over seizures in a long term after surgery with comprehensive preoperative evaluation.IED characteristics and seizure origins are not associated with surgical outcome,and ictal electroencephalography is not necessary for preoperative evaluation.

关 键 词：颞叶癫痫 发作期脑电图 发作间期癫痫样放电 手术疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]