术中皮层脑电残余痫样放电与术后癫痫发作关系探讨
发布时间：2018-08-19 17:04
【摘要】：目的:通过分析难治性症状性癫痫患者病灶切除后皮层脑电图(electrocorticography,ECoG)残余痫样放电类型[棘波、ripple、fast ripple(FR)]以及残余数量,探讨其与术后癫痫发作的关系。方法:回顾性分析重庆医科大学附属第一医院神经外科2010年1月至2015年1月共71例经外科切除性手术治疗的难治性症状性癫痫患者资料。患者术后随访时间1~5年。选取病灶切除后最后1次监测1min无干扰的ECoG数据。根据各残余痫样放电类型,分别分析残余棘波(1~40Hz,棘波组)、ripple(80~250Hz,R组)和FR(250~500Hz,FR组)3组观测指标,再根据各组内患者残余事件有无分为阳性(+)和阴性(-)亚组,比较各亚组内术后癫痫发作患者的数量;并统计各组患者残余事件的出现量,探讨各类残余痫样放电类型以及数量与术后癫痫发作的关系。结果:71例患者平均随访(2.3±1.5)年,术后癫痫控制(EngelⅠa)45(63.38%)例,术后癫痫发作(EngelⅠb~Ⅳ)26(36.62%)例。各残余事件组中:1.FR(+)患者术后癫痫发生显著高于FR(-)患者(12/17 vs 14/54,P0.01),残余FR对术后癫痫发作阳性预测值(positive predictive value,PPV)为70.59%,阴性预测值(negative predictive value,NPV)为74.07%;术后癫痫发作患者平均FR数量显著高于术后癫痫控制患者[(7.62±1.19)vs(5.24±1.30),P0.01]。2.R(+)患者术后癫痫发生高于R(-)患者(19/44 vs 7/27,P=0.14),残余R对术后癫痫PPV为43.18%,NPV为74.07%;术后癫痫发作患者平均R数量高于术后癫痫控制患者[(9.39±4.01)vs(8.06±3.09),P=0.13]。3.棘波(+)患者术后癫痫发生高于棘波(-)患者(21/52 vs 5/19,P=0.28),残余棘波对术后癫痫发作PPV为40.38%,NPV为73.68%;术后癫痫发作患者平均棘波数量高于术后癫痫控制患者[(14.38±5.82)vs(13.81±4.62),P=0.23]。结论:难治性症状性癫痫患者病灶切除后ECo G残余的FR可能是术后癫痫发作的电生理标识,且残余FR量较高时与术后癫痫发作关系更为密切。
[Abstract]:Objective: to investigate the relationship between residual epileptiform ripple (FR) and postoperative epileptic seizures in patients with intractable symptomatic epilepsy by analyzing the type of residual epileptiform discharge (ECoG) in patients with intractable symptomatic epilepsy. Methods: the data of 71 patients with refractory symptomatic epilepsy treated by surgical resection from January 2010 to January 2015 were retrospectively analyzed in the Neurosurgery Department of the first affiliated Hospital of Chongqing Medical University. The patients were followed up for 1 ~ 5 years. The ECoG data of 1min were monitored for the last time after resection. According to the type of residual epileptiform discharge, the three groups of residual spike wave (1 ~ 40 Hz, spike wave group) and FR (250 ~ 500 Hz ~ (-1) FR group) were analyzed respectively, and then according to whether the residual events were positive (-) or negative (-) in each group, To compare the number of patients with postoperative epileptic seizures in each subgroup, and to count the occurrence of residual events in each group, and to explore the relationship between the types of residual epileptiform discharge and the number of epileptic seizures after operation. Results 71 cases were followed up for an average of (2.3 卤1.5) years, 45 cases (63.38%) of postoperative epilepsy control (Engel 鈪，
本文编号：2192281
[Abstract]:Objective: to investigate the relationship between residual epileptiform ripple (FR) and postoperative epileptic seizures in patients with intractable symptomatic epilepsy by analyzing the type of residual epileptiform discharge (ECoG) in patients with intractable symptomatic epilepsy. Methods: the data of 71 patients with refractory symptomatic epilepsy treated by surgical resection from January 2010 to January 2015 were retrospectively analyzed in the Neurosurgery Department of the first affiliated Hospital of Chongqing Medical University. The patients were followed up for 1 ~ 5 years. The ECoG data of 1min were monitored for the last time after resection. According to the type of residual epileptiform discharge, the three groups of residual spike wave (1 ~ 40 Hz, spike wave group) and FR (250 ~ 500 Hz ~ (-1) FR group) were analyzed respectively, and then according to whether the residual events were positive (-) or negative (-) in each group, To compare the number of patients with postoperative epileptic seizures in each subgroup, and to count the occurrence of residual events in each group, and to explore the relationship between the types of residual epileptiform discharge and the number of epileptic seizures after operation. Results 71 cases were followed up for an average of (2.3 卤1.5) years, 45 cases (63.38%) of postoperative epilepsy control (Engel 鈪，
本文编号：2192281
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