长程视频脑电图监测在继发性颞叶癫痫伽玛刀治疗评估中的作用探究  

The role of video electroencephalogram monitoring in gamma knife radiosurgery for the treatment of secondary temporal lobe epilepsy

作　　者：王婷 周玉妮 刘森 刘琨 WANG Ting;ZHOU Yu-ni;LIU Sen(Electroencephalogram Room,Daizhuang Hospital of Shandong Province,Jining 272051,China)

机构地区：[1]山东省戴庄医院脑电图室,272051 [2]山东省戴庄医院神经内科,272051 [3]山东省戴庄医院伽玛刀治疗科,272051

出　　处：《中国实用医药》2025年第7期1-7,共7页China Practical Medicine

摘　　要：目的探讨长程视频脑电图(VEEG)对继发性颞叶癫痫患者伽玛刀立体定向放射外科(GKS)治疗的定位及其在疗效预测中的作用。方法选取76例行GKS治疗的继发性颞叶癫痫患者的临床资料,根据癫痫发作表现、影像学提示的病理灶、VEEG异常放电综合评估确定靶区,分析VEEG放电分布及其对GKS靶区定位的作用,VEEG与GKS疗效的关系。结果76例患者中,发作期放电(IDs)和发作间期癫痫样放电(IEDs)分布均与病理灶一致26例(34.21%);IDs分布与病理灶一致53例(69.74%);IEDs分布与病理灶一致39例(51.32%);66例在其颞叶病灶或其邻近区域出现脑电图IDs和(或)IEDs,另10例IDs和IEDs分布于非病理灶脑区。IDs、IEDs与病理灶、癫痫发作表现均一致22例,不完全一致54例。全组均以病理灶为靶区,其中3例IDs与病理灶侧别相反,以病理灶及其对侧杏仁核海马区为靶区。单侧IDs并同侧IEDs患者的GKS治疗有效率92.31%均高于单侧IDs并双侧IEDs的40.00%、双侧IDs并单侧IEDs的30.77%、双侧IDs并双侧IEDs的42.86%,差异有统计学意义(P<0.05)。73例患者以病理灶及其边缘或邻近组织为GKS治疗靶区,其中IDs和IEDs与病理灶一致的患者GKS治疗有效率92.31%明显高于仅IDs与病理灶一致的37.04%、仅IEDs与病理灶一致的38.46%、IDs和IEDs均与病理灶不一致的42.86%,差异有统计学意义(P<0.05)。51例患者病理灶与发作表现一致,其中与IDs和IEDs均一致患者的GKS治疗有效率90.91%均高于仅与IDs一致的35.29%、仅与IEDs一致的33.33%、与IDs和IEDs均不一致的0(P<0.05)。结论VEEG在继发性颞叶癫痫的GKS治疗定位评估中具有较高的准确性,其异常放电分布特征对GKS疗效有着预测作用。Objective To explore the localization role of video electroencephalogram(VEEG)in gamma knife radiosurgery(GKS)for patients with secondary temporal lobe epilepsy,and its role in predicting the efficacy.Methods The clinical data of 76 patients with secondary temporal lobe epilepsy undergoing GKS treatment were selected.The target area for GKS treatment was determined by a comprehensive evaluation of epileptic seizure manifestations,imaging pathological lesions,and abnormal VEEG discharges.Analysis of the distribution of VEEG discharges and its role in the localization of target areas of GKS treatment,and the correlation between VEEG and GKS efficacy.Results Among the 76 patients,26 cases(34.21%)had both ictal discharges(IDs)and interictal epileptiform discharges(IEDs)distributed consistently with the pathological lesions;53 cases(69.74%)had IDs distributed consistently with the pathological lesions;39 cases(51.32%)had IDs distributed consistently with the pathological lesions;66 cases showed IDs and/or IEDs in their temporal lobe lesions or their adjacent areas,and another 10 cases had IDs and IEDs distributed in non-lesional brain areas.IDs and IEDs in 22 cases were completely consistent with the pathological lesions and epileptic seizure manifestations,while 54 cases were not consistent.In all cases,the pathological lesions were used as the target areas.In 3 cases where IDs were located the contralateral side of the pathological lesions,the target areas were the pathological lesion and the contralateral amygdala and hippocampus.The effective rate of GKS treatment in patients with unilateral IDs and ipsilateral IEDs was 92.31%,which was higher than 40.00%in patients with unilateral IDs and bilateral IEDs,30.77%in patients with bilateral IDs and unilateral IEDs,and 42.86%in patients with bilateral IDs and bilateral IEDs,and the difference was statistically significant(P<0.05).In 73 patients,the pathological lesions and their margins or adjacent tissues were used as the target area for GKS treatment,in which the eff

关 键 词：继发性颞叶癫痫 长程视频脑电图 病理灶 伽玛刀立体定向放射外科 

分 类 号：R742.1[医药卫生—神经病学与精神病学]