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结节性硬化症伴顽固性癫痫脑电图分析及术前定位

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目的:探讨结节性硬化伴顽固性癫痫的脑电图特点及术前痫灶定位.方法:回顾性分析了37例(其中30例行手术治疗)结节硬化所致顽固性癫痫的多导多形式脑电图特点并结合临床、影像学及发作期ECT等综合定位.结果:局灶性放电(单灶)4例,一侧双灶7例,一侧多灶或双侧改变以一侧优势的17例,双侧镜灶1例,双侧双灶3例,双侧弥散性放电5例.28例患者可定侧,并与影像学检查、临床发作相一致.术中行皮质及深部电图探测,证实了术前定位.本组随访1-6年,平均3.5年.30例患者中有16例获得I级(Engel分级),7例获得Ⅱ级,5例为Ⅲ级,2例Ⅳ级.平均智商(IQ)从术前的55.4分提高到64.1分.结论:结节硬化伴顽固性癫痫EEG放电广泛,双灶或多灶性改变为主,大部分可通过多形式多导联脑电图定位,找出痫灶放电优势侧,并结合临床表现、影像学改变及发作期ECT等,找出原发痫灶并予以手术切除,可获得良好的治疗效果.
Characteristics of EEG and localization of epileptogenic loci for intractable epilepsy in patients with tuberous sclerosis
AIM: To investigate the characteristics of EEG and localization of epileptogenic foci for intractable epilepsy in patients with tuberous sclerosis (TS). METHODS: The EEG of 37 patients(Surgery of 30 TS patients of intractable epilepsy with TS) underwent multichannel, various types combined clinic data, ictal single photon emission computed tomography with imagine data were analyzed. RESULTS: A focal epileptic discharge was indicated in 4 of 37 patients, two epileptogenic focis in seven patients and multifocuses with seventeen frow unilateral hemishere were recorded, the mirror focus was showed in one patients, two epileptogenic focuses in 3 patients and general discharge in 5 patients. 30 cases were performed the surgical treatment, were explored and identified by ECoG and depth EEG. At follow-up, on average 3.5 years after surgery, 16 of 30 patients had an Engel Class Ⅰ outcome after surgery and an additional seven patients had rare seizure (Engel Class Ⅱ), and five patient had a decrease in seizure frequency(Engel Class Ⅲ). Mean intelligence quotient (IQ) improved from 55.4 to 64.1. CONCLUSION: There were general the epileptiform waves of intractable epilepsy in patients with TS, two focuses or multifocuses were indicated, but most of them can be recorded the unilateral predominace of epileptiform waves, and be combined with clinical manifestations, imagine data and ictal single photon emission computed tomography, and so on. The good outcomes can be obtained to find foci and resecting.

intractable epilepsytuberous sclerosisEEGepileptogenic foci localization

杨梅华、黄轶、刘仕勇、杨华安、杨辉、安宁、石先俊、张琴、蔡方成

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第三军医大学新桥医院神经外科,全军癫痫病诊治中心,重庆,400037

重庆医科大学附属儿童医院,临床分子医学中心,重庆,400014

重庆渝北区人民医院脑外科,重庆,401120

重庆医科大学附属儿童医院,神经内科,重庆,400014

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难治性癫痫 结节性硬化症 EEG 痫灶定位

2009

第四军医大学学报
第四军医大学

第四军医大学学报

CSTPCDCSCD北大核心
影响因子:0.599
ISSN:1000-2790
年,卷(期):2009.30(20)
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