14例起源于杏仁核的颞叶内侧型癫痫患者的致痫网络模式分析  

Epileptogenic network patterns in 14 patients with mesial temporal lobe epilepsy originating from the amygdala

作　　者：庄君 费凌霞 李恺煇 谈庆华 李淡芳 李花 蔡美玲 Zhuang Jun;Fei Lingxia;Li Kaihui;Tan Qinghua;Li Danfang;Li Hua;Cai Meiling(Department of Epilepsy,Guangdong Sanjiu Brain hospital,Guangzhou 510510,China)

机构地区：[1]广东三九脑科医院癫痫内科,广州510510

出　　处：《中华神经医学杂志》2024年第9期903-910,共8页Chinese Journal of Neuromedicine

摘　　要：目的探讨起源于杏仁核的颞叶内侧型癫痫患者的致痫网络模式。方法选择自2019年1月1日至2023年12月31日于广东三九脑科医院癫痫内科进行术前评估的14例起源于杏仁核的颞叶内侧型癫痫患者为研究对象,回顾性收集患者的临床资料,并进一步基于立体定向脑电图(SEEG)及PET-CT对其致痫网络模式进行探索。结果12例患者的颅脑MRI示一侧杏仁核肥大,2例示杏仁核T2 FLAIR序列信号增高但体积无明显改变。患者的间歇期头皮脑电图表现为一侧或双侧颞区放电(以病变侧为著),发作期头皮脑电图示放电起始侧别均与病变侧一致。本组患者共有3种临床表型及其对应致痫网络模式:第1种见于5例患者,临床特征为先兆→自动运动→植物神经症状,SEEG示发作自杏仁核→海马→岛前小叶→颞极,PET-CT示颞叶内侧结构低代谢。第2种见于6例患者,临床特征为先兆→过度运动/复杂运动→植物神经症状,SEEG示发作自杏仁核→海马→颞极→额眶回、前扣带回→岛叶,PET-CT示颞叶内侧结构、颞极、岛叶、额眶回及额叶内侧面低代谢。第3种见于3例患者,临床特征为先兆→双侧对称性肌张力障碍→植物神经症状、伴或不伴口咽部自动运动,SEEG示发作自杏仁核→海马及岛叶→颞极及邻近颞叶新皮层,PET-CT示颞叶内侧结构及岛叶低代谢。结论起源于杏仁核的颞叶内侧型癫痫患者的不同临床表型对应着不同的致痫网络模式。Objective To explore the epileptogenic network patterns in 14 patients with mesial temporal lobe epilepsy(mTLE)originating from the amygdala.Methods A total of 14 patients with mTLE originating from the amygdala underwent preoperative evaluation in Department of Epilepsy,Guangdong Sanjiu Brain Hospital from January 1,2019 to December 31,2023 were selected.A retrospective analysis was performed on the clinical data of these patients.Epileptogenic network patterns were further explored based on stereo-electroencephalogram(SEEG)and positron emission tomography-computed tomography(PET-CT).Results Craniocerebral MRI indicated 12 patients with unilateral amygdala hypertrophy,and 2 with increased T2-FLAIR signal in the amygdala but no obvious volume change.During interictal period,scalp EEG indicated discharges in one or both temporal regions and distinguished at the lesion side.During ictal period,scalp EEG indicated that the initial side is consistent with the lesion side.Three clinical phenotypes and epileptogenic network patterns were summarized:the first type(n=5)had clinical manifestations as aura→automotor→autonomic symptoms,with epileptic seizure starting from amygdala→hippocampus→preinsula→temporal pole(by SEEG)and low metabolism in the medial structures of the temporal lobe(by PET-CT);the second type(n=6)had clinical manifestations as aura→hypermotor/complex motor→autonomic symptoms,with epileptic seizure starting from amygdala→hippocampus→temporal pole→frontal orbital gyrus and anterior cingulate cortex→insula(by SEEG)and low metabolism in the medial structures of the temporal lobe,temporal pole,insula,frontal-orbital gyrus,and inner frontal lobe(by PET-CT);the third type(n=3)had clinical manifestations as aura→bilateral symmetrical dystonia→autonomic symptoms(with or without oral-alimentary automotor),with epileptic seizure starting from amygdala→hippocampus and insula→temporal pole and adjacent temporal neocortex(by SEEG)and low metabolism in the mesial structures of the tempor

关 键 词：杏仁核 颞叶内侧型癫痫 致痫网络 立体定向脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]