难治性颞叶癫痫头皮脑电发作起始形式与致痫病变的关系

发布时间：2018-07-04 19:10

本文选题：难治性颞叶癫痫 + 发作期头皮脑电　；参考：《第三军医大学学报》2017年22期

【摘要】：目的观察难治性颞叶癫痫(intractable temporal lobe epilepsy,ITLE)患者头皮脑电发作起始形式,并探讨其与致痫病变的关系。方法回顾性分析我院神经外科2011年9月至2015年9月45例ITLE患者的临床信息及其172次临床发作的视频脑电图资料,所有病例行切除性癫痫手术治疗,术后效果评估均为EngelⅠ级。根据术前MRI所示致痫病变部位的不同分为颞叶内侧癫痫(mesial temporal lobe epilepsy,MTLE)和颞叶新皮层癫痫(neocortical temporal lobe epilepsy,NTLE);术后病检可见6种不同病理类型。对发作期脑电起始形式进行分析,比较各种起始形式在不同部位及不同性质致痫病变的出现差异,探讨不同发作起始形式对致痫灶的定位价值及可能的神经电生理机制。结果 (1)45例患者172次临床发作期脑电中有明显起始形式157次,包括低幅快活动(low-voltage fast activity,LVFA)57次(36.3%),θ节律35次(22.3%),δ活动31次(19.7%),尖波活动20次(12.7%),低中幅多棘波14次(8.9%)。157次发作期脑电中局灶性起源103次(65.6%),LVFA占49次(47.6%),LVFA的定位率明显高于其他起始形式(P0.01)。(2)5种起始形式均可见于MTLE和NTLE,LVFA在NTLE的出现率明显高于MTLE(P0.01),慢活动(θ节律及δ活动)在MTLE的出现率高于NTLE(P0.05),尖波活动及低中幅多棘波在不同部位的出现差异无统计学意义(P0.05)。(3)5种起始形式可见于不同性质的致痫病变,θ节律在海马硬化(hippocampal sclerosis,HS)病变中的出现率高于其他病变类型(P0.05)。结论 ITLE发作期头皮脑电起始形式中LVFA有较好定位价值,θ节律对HS具有提示意义。
[Abstract]:Objective to observe the onset of scalp electroencephalogram (EEG) in patients with intractable temporal lobe epilepsy (intractable temporal lobe epilepsyn ITLE) and to explore the relationship between EEG and epileptiform. Methods the clinical information of 45 patients with ITLE from September 2011 to September 2015 and the video EEG data of 172 clinical seizures were retrospectively analyzed. According to the location of epileptiform lesions revealed by MRI before operation, the patients were divided into (mesial temporal lobe epilepsy-MTLE (medial temporal lobe epilepsy) and (neocortical temporal lobe epilepsy (NTLE). In this paper, the onset patterns of EEG during seizures were analyzed, and the differences of epileptic lesions in different sites and different properties were compared, and the localization value and possible neurophysiological mechanism of different onset patterns for epileptogenic foci were discussed. Results (1) in the 172 clinical seizures of 45 patients, there were obvious initial patterns 157 times. There were 57 (36.3%) low amplitude fast events (36.3%), 35 胃 rhythms (22.3%), 31 未 activities (19.7%), 20 sharp wave activities (12.7%), 14 low amplitude multi-spike waves (8.9%) .157times (65.6%) in focal origin of EEG, 49 times (47.6%) had significantly higher localization rate than other initial patterns. All of the five initiation forms of the formula (P0.01). (2) can be seen in the occurrence rate of MTLE and NTLEL LVFA in NTLE significantly higher than that in MTLE (P0. 01). The occurrence rate of slow activity (胃 rhythm and 未 activity) in MTLE is higher than that in NTLE (P0.05). There is no significant difference in the occurrence of sharp wave activity and low, medium amplitude and multi spike wave in different parts of MTLE. Significant (P0.05). (3) five initiation forms can be seen in different nature of epileptic lesions, 胃 rhythm in hippocampal sclerosis (hippocampal sclerosis HS) disease occurrence rate is higher than other types of lesions (P0.05). Conclusion LVFA has a good localization value in the onset of scalp EEG during ITLE attack, and 胃 rhythm is of significance for HS.
【作者单位】：重庆医科大学附属第一医院神经外科;
【基金】：重庆市卫生局重点课题(2012-1-008) 国家临床重点专科建设项目经费资助[(2011)170号]~~
【分类号】：R742.1

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