颞叶癫痫伴双侧海马硬化与单侧海马硬化的临床特征差异分析  

Differences of clinical characteristics between temporal lobe epilepsy with bilateral hippocampal sclerosis and temporal lobe epilepsy with unilateral hippocampal sclerosis

作　　者：陶琪 何晨敏 邱晶晶 杨育育 徐莎[1] 郭谊[1] 李宏 丁瑶[1] 丁美萍[1] 王爽[1] Tao Qi;He Chenmin;Qiu Jingjing;Yang Yuyu;Xu Sha;Guo Yi;Li Hong;Ding Yao;Ding Meiping;Wang Shuang(Department of Neurology,Second Affiliated Hospital,Medical School of Zhejiang University,Hangzhou 310009,China;Department of Radiology,Second Affiliated Hospital,Medical School of Zhejiang University,Hangzhou 310009,China;Department of Neurology,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]浙江大学医学院附属第二医院神经内科,杭州310009 [2]浙江大学医学院附属第二医院放射科,杭州310009 [3]湖州市中心医院神经内科,湖州313000

出　　处：《中华神经医学杂志》2024年第5期450-457,共8页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(82171437)。

摘　　要：目的探讨颞叶癫痫伴双侧海马硬化(TLE-bHS)与颞叶癫痫伴单侧海马硬化(TLE-uHS)临床特征的差异。方法回顾性纳入浙江大学医学院附属第二医院神经内科癫痫中心自2013年1月至2022年1月收治的48例明确诊断为TLE-bHS且临床资料完整的患者(TLE-bHS组),以及同期收治的101例明确诊断为TLE-uHS且临床资料完整的患者(TLE-uHS组),分析2组患者的临床资料如发病年龄、病程、既往病史、癫痫发作频率、抗发作药物种类、视频脑电图结果、神经心理测试结果以及治疗结局等方面的差异。结果与TLE-uHS组相比,TLE-bHS组患者男性占比更高,发病年龄更晚,病程更短,癫痫发作频率更高,既往及现用抗发作药物种类更多,癫痫发作时自主神经先兆比例更低、无先兆比例更高,视频脑电图中后头部背景活动偏慢比例更高,记忆商数、言语记忆评分及非言语记忆评分更低,差异均有统计学意义(P<0.05)。另外,2组患者既往病史构成比、发作间期癫痫样异常分布区域构成比的差异亦均有统计学意义(P<0.05),其中TLE-bHS组既往常伴有颅内感染/脑炎史,双侧颞区癫痫样异常比例更高;而TLE-uHS组常伴有热性惊厥史,单侧颞区癫痫样异常比例更高。TLE-bHS组患者中仅10例(20.8%)接受了非药物治疗,包括前颞叶切除手术3例(术后随访2年均为Engel分级Ⅰ级)、神经调控治疗4例、生酮饮食治疗4例;TLE-uHS组患者中55例(54.5%)接受了前颞叶切除手术,术后随访2年时Engel分级Ⅰ级48例(87.3%)、Ⅱ级1例(1.8%)、Ⅲ级4例(7.3%)、Ⅳ级2例(3.6%)。结论TLE-bHS患者与TLE-uHS患者在性别、既往病史、发病年龄、病程、癫痫发作频率、抗发作药物种类、视频脑电图、神经心理测试等方面的差异有助于将两者相鉴别。Objective To compare the differences of clinical characteristics of temporal lobe epilepsy with bilateral hippocampal sclerosis(TLE-bHS)with those of temporal lobe epilepsy with unilateral hippocampal sclerosis(TLE-uHS).Methods A retrospective analysis was performed.Forty-eight patients with confirmed TLE-bHS enrolled in Epilepsy Center,Department of Neurology,Second Affiliated Hospital,Medical School of Zhejiang University from January 2013 to January 2022 were chosen,and 101 patients with confirmed TLE-uHS admitted to our hospital at the same time period were selected as controls.Clinical data such as onset age,disease course,past medical history,seizure frequency,anti-seizure medications,video EEG and neuropsychological test results,and outcomes were analyzed.Results Compared with the TLE-uHS group,the TLE-bHS group had higher male proportion,elder onset age,shorter disease course,higher seizure frequency,more types of past and currently used anti-seizure medications,lower proportion of autonomic nerve with aura,higher proportion of no aura at onset,higher proportion of slow head background movement in video EEG,and lower memory quotient,verbal memory scores and non-verbal memory scores,with significant differences(P<0.05);the differences in ratio of past medical history and ratio of distributions of regions with interictal epileptiform abnormalities between the 2 groups were statistically significant(P<0.05):the TLE-bHS group had significantly higher proportion of previous intracranial infection/encephalitis and higher ratio of bilateral temporal epileptiform abnormalities than the TLE-uHS group,while the TLE-uHS group had significantly higher proportion of patients with febrile convulsion history and higher ratio of unilateral temporal epileptiform abnormalities(P<0.05).Only 10 patients(20.8%)in the TLE-bHS group received non-drug therapy,including anterior temporal lobectomy in 3 patients(Engel grading Ⅰ in postoperative follow-up for 2 years),neuroregulatory therapy in 4,and ketogenic diet in 4;of the 55

关 键 词：颞叶癫痫 双侧海马硬化 单侧海马硬化 

分 类 号：R742.1[医药卫生—神经病学与精神病学]