安定颈动脉内注射对两侧同步性痫样放电难治性癫癎灶定侧的意义  

Significance of lateralized focus of intra-carotid arterial diazepam injection for intractable epilepsy with bilateral synchronous epileptiform discharges

作　　者：贾开福[1] 崔勇[1] 张榜硕[1] 

机构地区：[1]重庆三峡中心医院急诊科,万州404000

出　　处：《第三军医大学学报》2004年第5期439-440,共2页Journal of Third Military Medical University

摘　　要：目的　探讨安定颈动脉内注射对两侧同步性痫样放电难治性癫疒间的痫灶定侧的意义。方法　对 2 0例两侧同步性痫样放电的难治性癫疒间 患者在脑电图 (EEG)监测下进行安定颈动脉内注射试验 ,观察注药后痫样放电受抑制情况来确定痫灶侧。结果　安定颈动脉内注射后 ,16例 ( 80 % )两侧同步性痫样放电消失 ,注药侧被判定致痫灶侧 ;4例( 2 0 % )注药侧癫疒间 样放电消失 ,对侧注药两侧痫样放电消失 ,即将再次注药侧判定为痫灶侧。 2 0例患者中 ,有 12例经手术脑皮质电图 (ECoG)、脑深部电图 (DEEG)证实定侧准确 ;手术及伽玛刀治疗后随访 1～ 6 5年 ,临床发作及脑电图检查痫样放电消失 15例 ( 75 % ) ,好转 5例 ( 2 5 % )。结论　安定颈动脉内注射对两侧同步性痫样放电难治性癫疒间Objective To explore the significance of intra carotid arterial diazepam injection in lateralization of intractable epilepsy with bilateral synchronous epileptiform discharges. Methods Intra carotid arterial diazepam injection test was performed in 20 patients suffering from intractable epilepsy with bilateral synchronous epileptiform discharges under EEG monitoring. Side of the epileptogenic focus was determined by observation of the inhibition of epileptiform discharges after injection. Results After diazepam injection, disappearance of bilateral synchronous epileptiform discharges was found in 16 patients (80%), so the injection side was decided as the epilepogenic focus. Disappearance of the epileptiform discharges was found at the injection side, but disappearance of the bilateral epileptiform discharges was found after injection at the opposite side in 4 cases (20%). The accuracy of lateralization was proved by surgery, electrocorticography (EcoG), and depth electroencephalography (DEEG) in 12 out of the 20 cases. During the follow up for 1-6 5 years after surgery and gamma knife treatment, disappearance of clinical seizure and epileptiform discharges of EEG and improvement were found in 15 cases (75%) and 5 cases (25%), respectively. Conclusion Intra carotid arterial diazepam injection is of important clinical value in lateralization of the epileptogenic focus before surgery for patients with intractable epilepsy.

关 键 词：安定 颈动脉 难治性癫痫 痫灶定侧 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R741.049[医药卫生—临床医学]