颞叶内侧型癫痫发作初期颅内脑电模式的研究  

Intracranial seizure-onset electroencephalogram patterns in mesial temporal lobe epilepsy

作　　者：杨浩然 张玮 尚丽 龚德山 刘兴洲 孙伟[1] 卢弘娟 Yang Haoran;Zhang Wei;Shang Li;Gong Deshan;Liu Xingzhou;Sun Wei;Lu Hongjuan(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurology,Beijing Tsinghua Changgung Hospital,Beijing 102218,China;Epilepsy Center,Shanghai Deji Hospital,Shanghai 200126,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]北京清华长庚医院神经内科,北京102218 [3]上海德济医院癫痫中心,上海200126

出　　处：《中华神经医学杂志》2024年第12期1211-1217,共7页Chinese Journal of Neuromedicine

基　　金：北京市博士后工作经费资助项目(2022-ZZ-027)。

摘　　要：目的探讨立体定向脑电图(SEEG)应用条件下,颞叶内侧型癫痫(MTLE)发作初期(包括发作起始及发作前期)的颅内脑电模式。方法回顾性分析上海德济医院癫痫中心自2017年3月至2019年12月收治的16例局灶性癫痫患者资料。将连续性放电作为发作起始的标志。发作间期向发作期的过渡期称为发作前期,特征是区别于发作间期的非持续性放电。对发作起始及发作前期的放电模式进行分类并分析二者间的对应关系,同时观察发作起始及发作前期放电的空间分布情况及同步性。结果16例入组患者共记录到132次惯常发作。发作起始阶段共出现2种放电模式:(1)低波幅快活动(LVFA)+慢去极化漂移(SPSs)(29次,22%);(2)低-中波幅的节律性活动(RA),不伴SPSs(103次,78%)。LVFA+SPSs的空间扩散范围远大于RA。发作前期放电模式包括3种:(1)超同步化(HYP)模式(93次,70.5%),最常出现于海马前部(87/219);(2)前哨棘波模式(22次,16.7%);(3)发作间期向发作期的平缓过渡模式(17次,12.9%)。发作前期与发作起始放电模式之间无明显对应关系。结论癫痫发作时的脑电图表现是从发作间期经发作前期向发作期逐渐演变的过程。HYP电位是MTLE最常见的发作前期模式,海马前部最易出现;RA电位为MTLE最常见的发作起始模式,其频率较低且空间扩散更局限。ObjectiveTo explore the seizure-onset intracranial electroencephalogram patterns in mesial temporal lobe epilepsy(MTLE)by stereo-electroencephalography(SEEG).MethodsThe clinical data of 16 patients with focal epilepsy admitted to Epilepsy Center,Shanghai Deji Hospital from March 2017 to December 2019 were retrospectively analyzed.Tonic discharge was taken as sign of the initial period;transition period from the interictal period to the initial period was named as the preictal period,characterized by clonic discharge that was different from the interictal period.The initial and preictal discharge patterns were described,and their corresponding relationship were studied;at the same time,the spatial distribution and synchrony of the discharges at initial and preictal periods were observed.ResultsOne hundred and thirty-two seizures were recorded in these 16 patients.Two patterns at initial period were noted:low-voltage fast activity(LVFA)+slow depolarizing shifts(SPSs,n=29,22%),and rhythmic activity(RA)of low-medium amplitude without SPSs(n=103,78%);spatial spread of LVFA+SPSs was much wilder than that of RA.In addition,3 patterns at preictal period were summarized:hypersynchronous(HYP,n=93,70.5%,most commonly found in the anterior hippocampus[87/219]),sentinel spike(n=22,16.7%),and pattern of smooth transition from the interictal period to the initial period(n=17,12.9%).No special correspondence in discharge patterns was noted between the initial period and preictal period.ConclusionSeizure is a process of gradual evolution from interictal period,preictal period to initial period.HYP potential is the most common pattern of seizure in MTLE at preictal stage,mainly appeared in the anterior hippocampus;RA potential is the most common pattern of seizure in MTLE at initial stage,with lower frequency and more limited spatial spread.

关 键 词：癫痫 颞叶内侧型 立体定向脑电图 发作起始模式 发作前期模式 

分 类 号：R74[医药卫生—神经病学与精神病学]