发作间期PET对难治性颞叶癫痫的诊断价值

目的分析18例颞叶癫痫患者的正电子发射断层扫描(PET)结果.方法 18例难治性癫痫患者,根据临床症状、脑电图/录像脑电监测(EEG/VEEG)、MRI海马相和单光子发射计算机体层摄影(SPECT)检查诊断为颞叶癫痫.均进行PET检查,结果有16例显示不同程度的颞叶前中部和(或)内侧部的低代谢区域.所有患者均在手术显微镜下采用显微外科技术进行手术,其中右侧颞叶癫痫16例行标准前颞叶及海马杏仁核切除术,左侧颞叶癫痫2例行选择性海马杏仁核切除术.结果随诊观察6～26个月,按照Engel的疗效判断标准,结果I级(癫痫发作消失)11例,II级(极少发作)4例,III级(发作减少75%以上)2例,IV(无改变)1例.结论对于临床上怀疑为颞叶癫痫而上述常规检查方法不能明确癫痫灶者,PET能更好地帮助诊断.

Diagnostic value of PET for intractable temporal lobe epilepsy during interphase of seizure

Objective To analyse the results of positron emission tomography (PET) in patients with intractable temporal lobe epilepsy.Methods Intractable temporal lobe epilepsy (TLE) was diagnosed in 18 patients by clinical observations, taking reference to electroencephalogram (EEG), video electroencephalogram (VEEG), magnetic resonance imaging (MRI) and single photon emisson computerized tomography (SPECT). Ipsilateral anterior-median temporal hypometabolism and/or interior temporal hypometabolism were showed with PET in 16 cases during interphase of seizure. 16 patients with right TLE underwent standard anterior temporal lobectomies and other 2 patients with left TLE selected amygdalo-hippocampectomy with microneurosurgical technique.Results There was no surgical morbidity or mortality. Follow-up (6-26 months) was available for all 18 patients (according to Engel's cure standard): Grade I (seizure free) in 11 cases, Grade II (few seizure) in 4 cases, Grade III (seizure reduced more than 75%) in 2 case and Grade IV (no changes) in 1 case. ConclusionPET can improve the positive rate of temporal lession which is not found by routine examination in patients with TLE.