磁共振成像阴性颞叶癫痫的临床特点分析

目的探讨磁共振成像(MRI)阴性颞叶癫痫(nonlesional temporal lobe epilepsy,TLE-NL)患者的临床特征、记忆水平和影像学特点。方法纳入2012年9月1日至2017年8月31日在浙江大学医学院附属第二医院确诊的44例单侧TLE-NL患者和53例同期就诊单侧颞叶癫痫伴海马硬化(temporal lobe epilepsy with hippocampal sclerosis,TLE-HS)患者,对TLE-NL和TLE-HS的临床特点进行对比。同时纳入20名健康志愿者作为正常对照组。采用韦氏记忆量表评估患者和对照组记忆功能,并通过高分辨率MRI定量分析海马体积及形态,评估TLE-NL和TLE-HS患者记忆水平和海马体积的改变。结果TLE-NL患者比TLE-HS患者发病年龄更晚(24.3±12.6)岁与(15.8±10.3)岁;t=3.684,P<0.01],癫痫病程更短4.00(2.00,8.75)年与14.00(7.50,22.00)年;Z=-4.675,P<0.01],热性惊厥史比例4.5%(2/44)与62.3%(33/53);χ2=32.270,P<0.01)和药物难治性比例更低47.7%(21/44)与84.9%(45/53);χ2=15.282,P<0.01)。TLE-NL患者在性别比例、癫痫家族史、致痫灶侧别、先兆发生率、症状学类型及发作频率上与TLE-HS患者类似。TLE-NL患者与正常对照组相比无明显记忆损害(记忆商数:105.2±17.4与103.8±16.2;P=1.000),而TLE-HS患者与正常对照组相比存在明显记忆损害(记忆商数:84.5±20.3与103.8±16.2;P<0.01)。TLE-NL患者海马体积和形态与正常对照组相比无明显改变,而TLE-HS患者存在明显致痫灶同侧海马萎缩(2953±481)mm3与(4431±505)mm3;P<0.01),形态分析结果提示萎缩以海马头及海马体部明显。结论TLE-NL是一类有别于TLE-HS的颞叶癫痫综合征,具有发病年龄晚、病程短、热性惊厥史少、药物难治性癫痫发生率较低、无明显记忆损害及海马萎缩的临床特点。

Clinical characteristics of nonlesional temporal lobe epilepsy

Objective To investigate the clinical characteristics,memory and neuroimaging features of nonlesional temporal lobe epilepsy(TLE-NL).Methods Forty-four patients with TLE-NL and 53 patients with unilateral temporal lobe epilepsy with hippocampal sclerosis(TLE-HS)were recruited from the Second Affiliated Hospital of Zhejiang University from September 1st 2012 to August 31st 2017.The clinical characteristics were systematically analyzed and compared between TLE-NL and TLE-HS.Twenty healthy volunteers were also recruited.Memory assessment and high resolution magnetic resonance imaging(MRI)scanning were completed in the patients and healthy volunteers.Volume and shape of the hippocampus were compared between patients and healthy volunteers.Results Compared with the TLE-HS,TLE-NL patients showed later seizure onset((24.3±12.6)vs(15.8±10.3)years;t=3.684,P<0.01),shorter duration of epilepsy((4.00(2.00,8.75))vs(14.00(7.50,22.00))years;Z=-4.675,P<0.01),less history of febrile convulsions(4.5%(2/44)vs 62.3%(33/53);χ2=32.270,P<0.01)and lower incidence of pharmacoresistant epilepsy(47.7%(21/44)vs 84.9%(45/53);χ2=15.282,P<0.01).However,there were no statistically significant differences between TLE-NL and TLE-HS in sex ratio,family history of epilepsy,lateralization of the epileptogenic zone,presence of aura,seizure types and seizure frequency.TLE-NL patients had normal memory quotient compared to normal controls(105.2±17.4 vs 103.8±16.2;P=1.000),while TLE-HS patients had significant memory impairment compared to normal controls(84.5±20.3 vs 103.8±16.2;P<0.01).Compared to normal controls,TLE-NL patients did not have significant alteration in hippocampal volume and shape,while TLE-HS patients had significant atrophy in the ipsilateral hippocampus((2953±481)mm3vs(4431±505)mm3;P<0.01),and shape analysis showed significant atrophy in the head and body of the hippocampus.Conclusion TLE-NL has different characteristics compared with TLE-HS,including later seizure onset,shorter duration of epilepsy,less history of febrile convulsions,better response to antiepileptic drugs,and no significant memory impairment and hippocampal atrophy.