难治性癫痫的外科治疗 (附47例报道)

目的 研究难治性癫痫的致痫灶精确定位和外科治疗方法,以减少癫痫发作次数和程度,改善患者生存质量。方法综合运用影像学、脑电图、PET．CT、脑功能皮层定位检查和偶极子定位与磁共振融合等方法,对47例难治性癫痫患者进行癫痫灶定位和外科手术治疗,并进行手术前后心理状况评估。结果随访评估疗效满意32例(68．1％),显著改善7例(14．9％),良好5例(10．6％),较差2例(4．3％),无改善1例(2．1％)。除1例巨大AVM术后有偏瘫,1例有计算障碍以外,无其他神经系统并发症．无死亡病例。结论综合应用影像学、电生理、核素检查和计算机图像融合技术,可以对大多数癫痫病灶的起源进行精确定位诊断,使难治性癫痫的外科治疗获得满意疗效。     

非酮症糖尿病性癫(癎)18例临床分析

目的 探讨非酮症糖尿病性癫(癎)的临床特点.方法 对18例非酮症糖尿病性癫(癎)患者的临床资料进行回顾性分析.结果 本组10例患者在血糖控制不理想状态下发生癫(癎),8例无明确糖尿病史以癫(癎)为首发症状;18例患者血糖均明显升高(16.8～32.1 mmol/L).14例表现为部分运动性发作(77.8%).应用胰岛素积极控制血糖后癫(癎)发作均得到控制.结论 非酮症糖尿病性癫(癎)可没有明确糖尿病史,以癫(癎)为首发,发作类型多为部分性发作,降低血糖是控制癫(癎)的有效方法.     

糖尿病合并癫痫38例临床分析

目的探讨糖尿病合并癫痫的临床特点,发病机制及防治措施。方法对38例糖尿病合并癫痫患者的临床资料进行回顾性分析,并结合文献进行讨论。结果糖尿病合并癫痫的患者中以老年人多见,尤其是既往有脑血管疾病的患者,以局限性运动性发作形式最多见,大部分患者脑电图无明显异常改变,控制血糖后癫痫发作停止或发作频率明显减少。结论癫痫的发作与血糖水平密切相关,平稳降糖有助于控制或减少癫痫发作。     

化脓性脑膜炎并发癫痫40例临床分析

目的 探讨化脓性脑膜炎与继发癫痫的关系.方法 回顾性分析近10年来我院收治的205例化脓性脑膜炎患者的临床资料,其中40例继发癫痫发作,统计化脑并发癫痫的发病率、发作时间、发作类型及转归.结果 化脓性脑膜炎癫痫发作的发病率为19.5%,其中儿童的发病率为25.4%;成人的发病率为10.1%,两组比较差异有显著性(P<0.01).部分性发作占50%(20/40),其中部分发作继发全身强直阵挛发作占12.5%(5/40);全身强直阵挛发作占42.5%(17/40),同时伴有两种发作类型的占7.5%(3/40).结论 化脓性脑膜炎可并发继发性癫痫发作,尤其是儿童,应注意防治.

Abstract：

Objective To study epilepsy associated with purulent meningitis.Methods Two hundred and five patients with purulent meningitis were analyzed retrospectively.among them 40 cases developed epilepsy.The 40 cases were analyzed on their incidence,seizure type and prognosis.Result The incidence of epilepsy associated with purulent meningitis Was 19.5%(40/205).The incidences of children and adults were respectively 25.4%(32/126)and 10.1%(8/79).The incidence of children Was higher than that of adults(P<0.01).Seizures of 50%(20/40)cases were the focalonset type,among them,12.5%(5/40)were with secondary generalization.Generalized seizures made up to 42.5%(17/40).7.5%(3/40)of cages had two types of seizures.Conclusions Purulent meningitis is a cominon cause of symptomatic epilepsy,especially for the children.We should take precautionary measures on it.     

641例脑囊虫病致癫痫临床分析

目的 探讨脑囊虫病致癫痫的临床特点及治疗方法。方法 通过对641例脑囊虫病致癫痫患者的回顾性分析，总结其临床特点、免疫水平、影像学及脑电图资料和治疗方法。结果 脑囊虫病致癫痫男性患者占78．47％，女性患者占21．53％，发作频率平均每年2—4次，发作类型以全身强直—阵挛发作(GTC)多见，囊虫免疫反应血IHA及血ELISA均为71．92％，脑脊液CAg阳性率78．40％，脑电图无特异性改变，影像学显示有各种类型脑囊虫病，胞二磷胆碱辅助治疗较用复方丹参更易诱发癫痫(P＜0．01)。结论 脑囊虫病致癫痫男性多于女性，发作频率不高，发作类型多样，免疫力低下，各种类型脑囊虫病均可导致癫痫，脑囊虫病辅助治疗慎用促脑代谢药物。     

Partial epilepsy and 47,XXX karyotype: report of four cases

Epilepsy is a common finding in chromosomal imbalances, but only a few chromosome abnormalities have a characteristic electro-clinical pattern. Trisomy X is one of the most common sex chromosome abnormalities in females, and is associated with considerable phenotypic variability. This report describes four 47,XXX females with mental deficiency and epilepsy. Although a specific electro-clinical pattern could not be defined, the epileptic phenotypes of these patients share many features; we suggest that the association 47,XXX/epilepsy/mental retardation may not be coincidental. This report also enlarges the clinical spectrum of the 47,XXX phenotype. Moreover, these observations highlight the critical role of chromosome X in epilepsy and mental retardation.     

癫痫1568例病因分析

目的分析癫痫的可能病因。方法收集资料完整的癫痫病例1568例,进行病因及热性惊厥史和家族史在不同病因组的阳性率统计。采用R×C表资料的χ2检验,分析比较各组病因分布、各年龄组症状性癫痫前5位病因、不同病因或癫痫与家族史和热惊厥史的相关性。结果特发性、症状性和症状可能性癫痫组病例分布,P<0.05;3组家族史比较,P=0.000,特发性癫痫与家族史关系密切。在症状性癫痫组中非成年人组病例占大多数,与成年组比较差异有统计学意义,前5位病因排序不同。海马硬化组热性惊厥史阳性率较高与非海马硬化组比较,p=0.000。结论癫痫病因复杂,不同起病年龄段病因分布不同;特发性癫痫与遗传因素明显相关;热性惊厥史和海马硬化,海马硬化与癫痫之间亦具有显著的相关性,症状可能性癫痫需要进一步深入研究,以期找到确切病因。     

35例成人难治性癫痫临床特点分析

目的 探讨成人难治性癫痫的临床特点.方法 采用回顾性分析与现场调查相结合的方法,对35例难治性癫痫患者与34例数药物治疗有效的癫痫患者的临床资料进行分析、比较.结果 与药物有效癫痫组相比,难治性癫痫组病程长、儿童期发病比例高、发作次数多、多种发作类型并存、女性月经期癫痫、抑郁状态发生几率明显增高;脑电图和CT或MRI异常的几率增高.结论 早期诊断并采用合适的方法治疗将在一定程度上改善难治性癫痫的预后.     

难治性癫痫172例临床病理分析

Objective To discuss the clinicopathologic characteristics of surgically removed tissues in patients with intractable epilepsy. Methods From 2008 to 2009, the histological sections of 172 specimens of cerebral epileptogenic foci, which were acquired by surgery, were performed respectively by HE staining and immunohisto - chemical staining,the characteristics of clinical pathology were also analyzed. Results Of all the 172 cases, according to the pathological features of the epilepto -genic foci, there were 138 focal cortical dysp lasia (FCD) ,including 115 FCD ⅠB, 15 FCD ⅡA and 8 FCD ⅡB, 2 micro cortical dysplasia, 4 dysembryoplastic neuropithelial tumors,7 Rasmussen's encephalitis, 16 ulegyrias; 1 ganglioneuroma; 1 microgyria malformation, 1 vascular malformation, 1 hypothalamic hamartoma, 1 tuberous sclerosis. ConclusionFCD is the most commonly present in intractable epilepsy, and FCDⅠB is most common among the FCD.     

难治性癫痫172例临床病理分析

目的 探讨难治性癫痫病灶切除手术患者的临床病理学分型及特点.方法 收集清华大学玉泉医院2008年1月至2009年6月,172例难治性癫痫手术治疗患者的病理标本及临床资料.采用HE和免疫组化染色,探讨各种类型癫痫病灶的临床病理学特点.结果 经病理诊断,局灶皮质发育不良138例(其中FCD Ⅰ B 115例、FCDⅡA 15例、FCDⅡB 8例)、微发育不良2例、胚胎发育不良性神经上皮瘤4例、Rasmussen脑炎7例、瘢痕脑回16例,节细胞瘤、多小脑回畸形、血管畸形、下丘脑错构瘤及结节性硬化各1例.结论 局灶皮质发育不良为引发难治性癫痫最常见病因,其中以FCDⅠ B亚型最为多见.     

难治性癫痫172例临床病理分析

Objective To discuss the clinicopathologic characteristics of surgically removed tissues in patients with intractable epilepsy. Methods From 2008 to 2009, the histological sections of 172 specimens of cerebral epileptogenic foci, which were acquired by surgery, were performed respectively by HE staining and immunohisto - chemical staining,the characteristics of clinical pathology were also analyzed. Results Of all the 172 cases, according to the pathological features of the epilepto -genic foci, there were 138 focal cortical dysp lasia (FCD) ,including 115 FCD ⅠB, 15 FCD ⅡA and 8 FCD ⅡB, 2 micro cortical dysplasia, 4 dysembryoplastic neuropithelial tumors,7 Rasmussen's encephalitis, 16 ulegyrias; 1 ganglioneuroma; 1 microgyria malformation, 1 vascular malformation, 1 hypothalamic hamartoma, 1 tuberous sclerosis. ConclusionFCD is the most commonly present in intractable epilepsy, and FCDⅠB is most common among the FCD.     

脑卒中后继发癫与性发作临床分析

目的总结和探讨脑卒中患者继发癫与性发作的发病率、病因、发病特点、诊断、治疗、预后及两者差异。方法回顾性分析我院近4 a来治疗的1 125例脑卒中患者的临床资料,对82例病例的发病时间、次数、脑电图情况及治疗、预后进行分析、研究。结果脑卒中患者继发癫及性发作的发病率为7.29%(82/1 125),累及皮层者发病率高。早期发作49例中36例仅发作1次,发作2次以上者9例,其中4例发生癫持续状态。迟发者33例中发作2次以上者有30例。40例行脑电图检查异常者仅12例。早期发作多为性发作,不需抗癫治疗,迟发者多为卒中后癫,需正规抗癫治疗。结论脑卒中后继发癫的发病率明显低于目前报道,许多诊断为癫者实际上仅是性发作,大多数卒中后癫及性发作预后较好,但癫持续状态预后差。     

脑卒中后继发性癫(癎)的临床分析

目的探讨脑卒中后继发性癫癎的临床特点、发病机制、脑电图改变及治疗。方法对46例脑卒中后继发癫癎患者的发病时间、临床表现、治疗方法及脑电图变化进行分析。结果547例脑卒中后继发癫癎46例(8.409%)。早发型明显多于迟发型,起病时间与病变性质无关;癫癎的发生与卒中部位、颅内高压及电解质紊乱有关。脑电图改变以慢波、尖/棘波多见,发作类型以单纯部分性运动发作多见。结论脑卒中累及大脑皮质或脑血液循环障碍或机械牵拉导致神经元异常放电时癫癎易发作,早期预防,可减少卒中患者继发性癫癎发作。     

迟发性外伤性颅内血肿47例临床分析

目的 探讨迟发性外伤性颅内血肿（DTICH）的临床特点,发病机制，以及早期诊断和治疗。方法 回顾性分析47例DTICH临床和影像学资料。结果 恢复良好35例，中残7例，重残2例，植物生存1例，死亡2例。结论 脑挫裂伤、蛛网膜下腔出血、颅骨骨折、高龄为DTICH的高危因素，早诊早治可以改善预后。