诱发电位联合皮层脑电监测指导中央区继发性癫痫手术治疗

【摘要】 目的 探讨联合皮层体感诱发电位(Co-SEP)、皮层运动诱发电位（Co-MEP）、及皮层脑电监测（ECoG）对进行大脑功能区和致痫灶定位并手术治疗的效果。方法 30例致痫灶位于中央区及其邻近部位的癫痫患者,术前通过神经影像、电生理等技术综合评估,术中运用Co-SEP、Co-MEP、ECoG,准确定位致痫灶及功能区,尽量全切病变及致痫灶治疗继发性癫痫,同时保护重要脑功能。结果 根据Engel标准,对30例病人术后随访6～18个月,Ⅰ级者18例;Ⅱ级者7例,Ⅲ级者3例,Ⅳ级者2例。所有病人术后均无永久性肢体运动功能障碍。结论 术中联合Co-SEP、Co-MEP、ECoG,能安全、准确、有效的指导脑中央区病变及致痫灶的治疗,在避免运动皮层损伤的同时,最大限度切除病变,治疗继发性癫痫,提高患者的生存质量。     

全麻唤醒和术中神经电生理技术在涉及语言功能区癫手术中的应用

目的:探讨全麻唤醒联合术中神经电生理技术在涉及语言功能区癫癎手术中的应用及其意义.方法:9例患者术前评估定位致癎病灶和(或)致癎灶和语言功能区及其关系,术中皮层电极(ECoG)监测癎性放电区,全麻唤醒下皮层电刺激(CES)定位语言功能区,在保护好语言功能区的前提下最大程度地切除致癎病灶和(或)致癎灶,再次行ECoG监测,对仍有癎性放电的区域行皮层热灼(BCFC)或多处软膜下横切(MST)直至ECoG监测满意为止,术后评估患者语言功能和癫癎控制情况.结果:9例患者中有1例术后第1天即出现程度不同的语言障碍并遗留部分运动性失语,3例在术后第2天出现语言障碍并于1周左右开始恢复,2周内恢复至术前.9例患者中7例癫癎控制为EngelⅠ,2例为EngelⅡ.结论:全麻唤醒和术中电生理技术应用有助于安全准确地处理涉及语言功能区的致癎病灶和(或)致癎灶及癎性放电区,降低语言功能损害的发生率,提高患者术后的生活质量.     

全麻唤醒和术中神经电生理技术在涉及语言功能区癫痫手术中的应用

目的：探讨全麻唤醒和术中神经电生理技术在涉及语言功能区癫痫手术中的应用及其意义。方法：9例患者术前评估定位致痫病灶和（或）致痫灶和语言功能区及其关系,术中皮层电极（ECoG）监测痫性放电区,全麻唤醒下皮层电刺激（CES）定位语言功能区,在保护好语言功能区的前提下最大程度的切除致痫病灶和（或）致痫灶,再次行ECoG监测,对仍有痫性放电的区域行皮层热灼(BCFC)或多处软膜下横切(MST)直至ECoG监测满意为止,术后评估患者语言功能和癫痫控制情况。结果：9例患者中有1例术后第1天即出现程度不同的语言障碍并遗留部分运动性失语,3例在术后第2天出现语言障碍并于1周左右开始恢复,2周内恢复至术前。9例患者中7例癫痫控制为EngelⅠ,2例为EngelⅡ。结论：全麻唤醒和术中电生理技术应用有助于安全准确的处理涉及语言功能区的致痫病灶和（或）致痫灶及痫性放电区,降低语言功能损害的发生率,提高患者术后的生活质量。     

皮层脑电监测在胚胎发育不良性神经上皮肿瘤术中的应用

目的探讨胚胎发育不良性神经上皮肿瘤（DNT）术中应用皮层脑电监测（ECoG）对术后癫痫控制率的影响。方法回顾5年来本院收治的10例DNT患者,全部患者以癫痫为主要表现并全部接受手术治疗,6例患者术中应用皮层脑电监测,全部患者术后长期随访。结果应用术中皮层脑电监测的6例患者,随访期内未出现癫痫复发的表现,4例未应用术中皮层脑电监测的患者,有3例术后出现不同程度的癫痫复发。结论术中应用皮层脑电监测对于控制DNT患者术后癫痫复发有积极作用。     

术中皮层及皮层下电刺激在脑功能区胶质瘤手术中的应用探讨

目的：探讨在脑功能区胶质瘤手术中皮层及皮层下电刺激对临床治疗效果的作用。方法选择脑功能区胶质瘤患者50例患者，分为麻醉下术中进行皮层电刺激治疗的皮层组及胶质瘤切除术中进行皮下电刺激的皮层下组，观察脑功能区与胶质瘤之间的关系。结果两组患者治疗后KPS评分较前升高，与治疗前相比差异具有统计学意义（P＆lt;0.05）。结论在脑功能区进行胶质瘤手术过程中应用皮层电刺激及皮层下电刺激，可准确定位脑功能区，尽可能完全切除肿瘤的同时保护脑功能区。     

皮层脑电图监测下手术治疗儿童继发性癫痫的疗效探讨

目的探讨皮层脑电图监测下儿童继发性癫痫的手术治疗效果。方法124例继发性癫痫患儿,术中通过皮层脑电图定位癫痫灶,显微手术切除原发病变后,再根据癫痫发作的临床表现、病灶部位及皮层脑电图监测所提示的异常脑电图波释放决定是否进行致痫灶切除、扩大致痫灶切除、皮层热灼术、前颞叶切除术、海马杏仁核切除术及胼胝体前部切开术。术后规范应用抗癫痫药物。结果124例患儿切除病变前皮层脑电图均可记录到癫痫波,原发病变切除后即时皮层脑电图监测病变周围可记录到异常癫痫波112例,检出率为90.32%。其中38例致痫波发放区域位于非功能区者该范围内皮层予以完全切除,术后即时皮层脑电图提示癫痫波消失;74例位于或毗邻重要功能区者,采用低功率热灼该处皮层后,69例癫痫波消失,5例患者经联合胼胝体前部切开和(或)海马、杏仁核切除,术后即时皮层脑电图监测效果满意。术后随访18个月至6年,按Engle标准评定疗效:Ⅰ级87例(68.50%),Ⅱ级30例(24.19%),Ⅲ级5例(4.03%),Ⅳ级2例(1.61%);手术总有效率为94.35%。89例患者停止服用抗癫痫药物满1年且无癫痫发作;24例患者低剂量维持;11例患者停药后癫痫复发再次服用初始量,发作频率较术前明显减少。结论皮层脑电图监测下,不同术式应用可明显提高儿童继发性癫痫手术治疗的效果。     

小剂量靶控输注丙泊酚在癫(痫)患者致(痫)灶切除术中研究的应用

目的 探讨小剂量靶控输注丙泊酚在癫(痫)患者致(痫)灶切除术术中脑电监测期间应用的可行性.方法 40例行致(痫)灶切除术的患者,完全随机分为停用丙泊酚组(20例)和靶控输注丙泊酚组(20例).在术中行皮质脑电图监测(ECoG)前15 min,停用丙泊酚组停止注入丙泊酚,靶控输注丙泊酚组将丙泊酚靶浓度改为1 mg/L.比较2组患者从改变丙泊酚输注浓度到可顺利进行ECoG期间呛咳,躁动的发生率以及术中知晓的发生率是否有差异.结果 从停药到可顺利进行ECoG,停用丙泊酚组所需时间为(27±7) min,靶控输注丙泊酚组所需时间为(27±5)min,组间差异无统计学意义(P＞0.05).靶控输液丙泊酚组脑电监测期间平均动脉压、心率、电双频谱指数均低于停用丙泊酚组[分别为(97.6±2.0) mm Hg比(89.4±1.4)mm Hg(1 mm Hg=0.133 kPa),(68±10) min比(86±15) min,(65±9)比(72±9)],差异均有统计学意义(均P＜0.05).停用丙泊酚组患者中2例出现术中知晓,靶控输注丙泊酚组患者无术中知晓的发生.结论 相对于停用丙泊酚,脑电监测期间靶控输注小剂量的丙泊酚(1 mg/L)既不影响脑电监测,又可以减少术中知晓的发生率,适于致(痫)灶切除术中脑电监测期间麻醉管理的应用.     

颞叶癫痫的手术治疗(附26例报告)

目的提高药物难治性癫痫的致痫灶精确定位和外科治疗水平。方法对26例颞叶癫痫患者应用长程视频脑电进行术前监测定位和皮层电极、深部电极进行术中定位;采用显微外科技术进行病灶+颞叶切除或颞叶+海马杏仁核切除。结果26例患者根据脑电图,18例患者根据MRI检查定位了致痫灶。术后无病死和严重并发症,服用抗癫痫药物减少;随访6～18个月,1级16例,2级6例,3级4例。结论长程视频脑电图和MRI检查是定位癫痫灶可靠的检查方法。应用显微外科技术可减少并发症,取得较好的治疗效果。     

辅助性皮层热灼治疗功能区顽固性癫痫27例报道

癫痫是危害较大的常见症状,约20%的病人长期药物治疗无效,称为顽固性癫痫,其中至少有50%的病人适合手术治疗[1]。致痫灶位于非功能区时,手术切除可得到较好的治疗效果;当致痫灶位于功能区时,可采用皮层双极电凝术治疗,可以较好的控制癫痫的发作。2009年7月~2012年7月对27例功能区顽固性癫痫患者进行皮层双极电凝手术治疗,经3月以上的随访,临床疗效满意,现总结报道如下。     

明天也许我能知道你在想什么：脑诱发电位的应用展望

人的大脑表层可以记录到两大类脑电位活动:自发性节律的脑电图和与刺激相关的脑诱发电位。其中眼、耳、皮肤等感觉器官在感受光、声等刺激后,将所感受的信息通过神经通路向大脑中枢传递,其信息内容在神经通路和大脑皮层引起一连串电活动,这种生物电活动变化引出的电位波动称为:脑诱发电位。     

Evaluation of sensory evoked potentials in Long Evans rats gestationally exposed to mercury (Hg0) vapor.

Mercury is known to alter neuronal function and has been shown to cross the placental barrier. These experiments were undertaken to examine if gestational exposure to mercury vapor (Hg(0)) would result in alterations in sensory neuronal function in adult offspring. Dams were exposed to 0 or 4 mg/m(3) Hg(0) for 2 h/day from gestational days 6-15. This exposure paradigm has been shown to approximate a maximal tolerated dose of Hg(0) for the dams. Between postnatal days 140-168, male and female offspring (one of each gender/dam) were examined using a battery of sensory evoked potentials. Peripheral nerve action potentials, nerve conduction velocity, somatosensory evoked responses (cortical and cerebellar), brainstem auditory evoked responses, pattern evoked potentials, and flash evoked potentials were quantified. Gestational exposure to 4 mg/m(3) Hg(0) did not significantly alter any of the evoked responses, although there was a suggestion of a decrease in compound nerve action potential (CNAP) amplitudes in male animals for the 3 mA stimulus condition. However, this possible change in CNAP amplitudes was not replicated in a second experiment. All evoked potentials exhibited predictable changes as the stimulus was modified. This shows conclusively that the evoked responses were under stimulus control, and that the study had sufficient statistical power to detect changes of these magnitudes. These results indicate that gestational exposure to 4 mg/m(3) Hg(0) did not result in changes in responses evoked from peripheral nerves, or the somatosensory, auditory, or visual modalities.     

Opiates and opioid peptides modify sensory evoked potentials and synaptic excitability in the rat dentate gyrus

The effects of morphine and the synthetic opioid peptide D-Ala2-MePhe4-Met-O-ol-enkephalin (FK 33-824) on averaged (AEPS) potentials evoked by a tone and extracellular synaptic potentials (EPSs) in the perforant path, recorded from the outer molecular layer (OM) of the dentate gyrus, were examined in rats trained to respond in an auditory discrimination task. Potentials evoked by a tone were systematically altered by both peripheral (intraperitoneal) and central (intracerebroventricular) administration of opioids. The short-latency negative (N1) component of the average evoked potential was increased in amplitude and the longer-latency negative (N2) component was decreased in amplitude by administration of opioids. At the same time, perforant path extracellular synaptic potentials were enhanced after administration of opioids. The changes in the average evoked potential and extracellular synaptic potentials in the perforant path were reversed by subsequent administration of naloxone. The significance of these results is discussed in terms of a possible role of endogenous opioid peptides in modulating the synaptic efficacy of the perforant path during the transmission of sensory information to the hippocampus from the entorhinal cortex.     

海洛因依赖者脑诱发电位研究

目的探讨海洛因依赖者听觉诱发电位和视觉诱发电位的变化特点及其应用。方法使用意大利百胜有限公司Galileo Sirius全数字化32导脑诱发电位仪对32例海洛因依赖者和30例正常人听觉诱发电位和视觉诱发电位的变化进行对照分析。结果海洛因依赖者具有以下特点(1)与正常人比较,海洛因依赖者AEP,VEP波形稳定性差、清晰度降低、粗糙,偶有切迹或双峰波,尤以主波群(N1-P2-N2)最明显;(2)与正常人比较,海洛因依赖者AEP,VEP中波N1,P3潜伏期延长(P<0.05),波P2,N2潜伏期缩短(P<0.05),同时N1-P2,P2-N2、P2波幅降低(P<0.05或P<0.01)。结论海洛因依赖者的AEP,VEP有一定特点,结合吸毒史、戒断症状和尿检吗啡阳性等指标对其诊断具有很大意义。     

磁共振波谱分析及皮层脑电图在难治性癫痫手术中的定位意义

目的 探讨磁共振波谱分析结合皮层脑电图在手术治疗难治性癫痫定位癫痫灶的意义.方法 对16例难治性癫痫患者,根据其临床发作类型、体征、磁共振波谱分析、皮层脑电图定位癫痫灶,同时对癫痫灶进行手术干预.结果 随诊6个月～5年.根据1996年Engel疗效分级标准评测:Ⅰ级为10例、Ⅱ级为2例、Ⅲ级为3例、Ⅳ级为1例.Ⅰ级、Ⅱ级12例为临床治愈,Ⅲ级3例为好转,治愈率为75％,治愈好转率为93.8％.结论 磁共振波谱分析可在癫痫外科术前评估中发挥重要作用,结合皮层脑电图可提高致痫灶定位的准确率,提高手术的效果.     

海洛因依赖者脑干听觉诱发电位研究

目的:探讨海洛因依赖者脑干听觉诱发电位的变化特点及其应用。方法:使用意大利百胜有限公司GalileoSirius全数字化32导脑诱发电位仪对32例海洛因依赖者和30例正常人脑干听觉诱发电位的变化进行对照分析。结果:海洛因依赖者波形稳定性较差,波Ⅰ、Ⅲ、Ⅴ出现率100%,以后依次为波Ⅳ、波Ⅱ、波Ⅵ、波Ⅶ,但与正常对照组比较,差异无显著性(P>0·05);波Ⅱ-波Ⅶ绝对潜伏期较正常人延长,其差异有显著性(P<0·05,P<0·01);波Ⅱ-波Ⅶ绝对波幅较正常人降低,其差异有显著性(P<0·05,P<0·01)。结论:海洛因依赖者的脑干听觉诱发电位具有波Ⅱ-波Ⅶ绝对潜伏期延长、绝对波幅降低的特点,这些特点除可作辅助诊断外,还能对早期预防依赖者的中枢神经系统并发症提供依据,同时建议对依赖者进行神经营养治疗。     

Effects of ReN1869, a CNS‐available antihistamine,on capsaicin‐ and histamine‐induced neurogenic inflammation in healthy subjects

ReN1869 (elsewhere referred to as NNC 05‐1869) is a new tricyclic compound which is chemically related to amitriptyline, but is without any significant interaction with other receptors except for the histamine H₁‐receptor, where it functions as an antagonist. The compound exhibits antinociceptive effects in rodent models of chronic pain and is effective against inflammation of neurogenic origin. The present trial was designed to assess the effect of a single dose of ReN1869 in humans on neurogenic inflammation induced by capsaicin and histamine and on the concomitant itch and pain sensation. Twenty‐four healthy male subjects were enrolled in this randomized, double‐blind, two‐period, crossover trial consisting of a single oral dose of 95 mg ReN1869 and matching placebo. Thirty minutes after dosing the participants received, in a randomized order, either histamine (on the skin of the palmar forearm, prick test) before capsaicin (on the skin of the back) in both trial periods and capsaicin before histamine in both periods. Several pharmacodynamic tests were performed after the capsaicin/histamine application: laser somatosensory‐evoked potentials (Laser‐SEP), sensory and pain threshold to laser stimuli of increasing intensity, planimetry of areas of wheal and flare, pinprick hyperalgesia, brush‐evoked pain, allodynia, skin reflection spectrometry (colorimetry), and visual analog scale of itch. ReN1869 had significant effects on the histamine‐induced phenomena. No wheal could be evoked in 14/21 evaluated subjects in contrast to all placebo‐treated subjects. The area of flare was reduced by 80% and itching by 65%. The flare induced by capsaicin was only slightly (not significantly) reduced by ReN1869. However, ReN1869 strongly influenced Laser‐SEP evoked by nociceptive stimuli from the capsaicin‐treated skin area by a 25% reduction of the amplitude of the P2 component, whereas the N1 component was not affected. This observation reflects a central analgesic effect without a peripheral component. The dosing was well tolerated and no particular adverse events were related to the trial drug. Conclusively, ReN1869 represents a new class of antihistamines that has antiinflammatory properties (related to antihistaminergic effects) as well as central analgesic effects (probably mediated centrally through histamine H₁ receptors). Drug Dev. Res. 57:193–199, 2002. © 2003 Wiley‐Liss, Inc.     

Electroretinographic and optical coherence tomography findings in breast cancer patients using aromatase inhibitors

Background: The present cross-sectional study has the purpose to investigate the impact of aromatase inhibitors (AIs) on retinal nerve fiber layer (RNFL) thickness, optic nerve and macular function in patients using AIs for breast cancer treatment.

Methods: Participants in our study were 41 hormone-receptor-positive earlystage breast cancer patients who were treated with AIs in the adjuvant setting. Moreover, 40 age- and gender-matched control subjects, having neither ocular nor systemic disorders, were included in this study. All participants underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA) assessment, RNFL thickness and central foveal thickness (CFT) measurement, visual evoked potentials (VEP) recording and multifocal-electroretinogram (mf-ERG) recording. Univariate and multiple regression analyses were performed.

Results: At the multiple regression analyses, patients receiving AIs presented with lower average RNFL and inferior RNFL. Moreover, similarly to the univariate analysis, intake of AIs was associated with lower amplitude P100, lower retinal response density in ring 1 and ring 2, longer peak time P100 and longer P1 time in ring 1.

Conclusion: Our study is the first in the literature investigating the potential effect of AIs on RNFL thickness, optic nerve and macular function in patients using AIs for breast cancer treatment. The principal message of our study is that patients using AIs exhibited a significant decrease in RNFL thickness (average, superior and inferior), retinal response density and visual acuity compared to healthy controls, while VEP findings (both amplitude and peak time of P100) differ significantly as well.     

大剂量免疫球蛋白抑制马桑内酯诱发的大脑神经元痫样放电

目的：研究大剂量免疫球蛋白的抗癫痫作用。方法：本实验采用大脑皮层应用化学致痫剂马桑内酯致痫大鼠，预先静脉注射大剂量免疫球蛋白致痫动物皮层脑电图痫样波频率，振幅，发生的潜伏期和皮层诱发电位振幅的影响。结果：大剂量免疫球蛋白可抑制部分致痫大鼠皮层诱发电位的振幅，脑电图痫样波的频率和振幅，使诱发痫样波发生的潜伏期延长。腹腔注射儿茶酚胺能神经元化学切割剂6－羟多巴可部分抑制免疫球蛋白的效应。结论：免疫球蛋白的上述作用可能与抑制去甲肾上腺有神经递质释放有关。     

Monoamine oxidase inhibition cannot account for changes in visual evoked potentials produced by chlordimeform

Chlordimeform (CDM), a formamidine insecticide and monoamine oxidase (MAO) inhibitor, has recently been shown to produce large changes in visual evoked potentials of hooded rats (Boyes and Dyer, 1984a). Two experiments were performed to determine if the changes in evoked potentials were a result of the inhibition of MAO. In the first, the degree of inhibition of MAO in the brains of rats treated with chlordimeform (1.0-100 mg/kg, i.p.) was compared with that produced by pargyline (0.3-30 mg/kg, i.p.). Both compounds preferentially inhibited MAO-B, although MAO-A was substantially inhibited at larger doses. Pargyline was a relatively more potent inhibitor of MAO than chlordimeform, but not more efficacious. In the second experiment, pattern reversal evoked potentials (PREPs) and flash-evoked potentials (FEPs) were recorded from groups of rats after treatment with either saline, 0.4 mg/kg pargyline, 20 mg/kg pargyline or 40 mg/kg chlordimeform. The latter two groups were selected so as to have similar levels of inhibition of MAO, about 90% inhibition of MAO-B and 60% inhibition of MAO-A. The results showed a doubling of the amplitude of pattern reversal evoked potentials and increased latencies of the pattern reversal evoked potential and the flash-evoked-potentials in the chlordimeform-treated group, but no significant changes from saline control values in the pargyline-treated groups. These results confirm that chlordimeform is a MAO inhibitor at doses which produce behavioral and electrophysiological changes, but demonstrate further that the changes in visual evoked potentials produced by chlordimeform are not a direct result of the inhibition of MAO.