选择性杏仁核海马切除术治疗颞叶内侧型癫(癎)疗效分析

目的 探讨选择性杏仁核海马切除术对治疗颞叶内侧型癫(癎)的疗效.方法 选择颞叶脑电异常与海马硬化同侧病例10例,其中单纯部分性发作继发全身性发作2例,复杂部分性发作5例(3例继发全身性发作),全身强直-阵挛性发作3例.经颞底海马旁回入路切除杏仁核海马.结果 术后病人均恢复良好.所有病例均随访1 a以上,6例发作完全缓解(EngelⅠ、Ⅱ级,60%),2例缓解明显(Engel Ⅲ级,20%),1例轻度缓解(Engel Ⅳ级,10%),1例病人术后半年自行停药造成癫(癎)复发.结论 对伴同侧海马硬化的颞叶内侧型癫(癎)患者行选择性杏仁核海马切除术(经颞底海马旁回入路)疗效显著,可改善性发作情况.     

立体定向热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫

目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫癎患者的临床表现、影像学（CT/MRI）脑电图（EEG/VEEG）资料和手术疗效。所有病例术前均行动态脑电图检查明确致癎灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致癎灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12～42个月，13例癫癎未再发作（满意），4例发作次数减少75%以上（明显改善），2例发作次数减少50%（改善）。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫癎，采用立体定向手术行海马杏仁核热凝毁损是控制癫癎发作的一种安全有效方法。     

立体定向热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎

目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫癎患者的临床表现、影像学（CT/MRI）脑电图（EEG/VEEG）资料和手术疗效。所有病例术前均行动态脑电图检查明确致癎灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致癎灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12～42个月，13例癫癎未再发作（满意），4例发作次数减少75%以上（明显改善），2例发作次数减少50%（改善）。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫癎，采用立体定向手术行海马杏仁核热凝毁损是控制癫癎发作的一种安全有效方法。     

立体定向杏仁核海马毁损治疗颞叶癫癎

目的 探讨立体定向杏仁核海马毁损治疗颗叶癫(癎)的原理、方法 和疗效.方法 患者头部安装MD-2000立体定向框架,使其平行于颞角长轴.针对12例颗叶顽固性癫(癎)患者,应用头部MRI扫描定位.局麻下深部电极行杏仁核及海马脑电监测和射频毁损术.结果 射频毁损前12例患者深部电极均记录到杏仁核和海马区棘波、尖波或多棘波,术后显示(疴)样放电消失.术后随访9～18个月,癫(癎)发作完全控制者58.3%(7/12),显著改善33.3%(4/12).结论 立体定向杏仁核海马毁损术治疗颞叶顽固性癫(癎)是一种安全有效的微创治疗方法 ,值得临床推广.     

神经导航锁孔入路选择性杏仁核海马切除术治疗内侧颞叶癫(癎)(附23例分析)

目的 探讨神经导航下锁孔入路选择性杏仁核海马切除术治疗内侧颢叶癫(癎)的疗效及手术经验.方法 回顾性分析23例药物难治性内侧颞叶癫(癎)的手术经验.均在无框架神经导航指引下,经颢部锁孔开颅,在显微镜下分开一小段颞下沟,切开侧脑室颢角前外侧壁后进入侧脑室,选择性切除杏仁核海马,并将海马旁回和钩回逐步吸除.结果 本组无严重手术并发症发生.术后随访24-57个月,Engel Ⅰ级(发作完全消失)17例(73.9%),Ⅱ级4例(17.4%),Ⅲ级2例(8.7%).结论 神经导航下经锁孔颞下沟入路选择性杏仁核海马切除术是治疗内侧颞叶癫(癎)的有效方法,手术创伤小,可妥善保护语言区和视放射,安全性高.     

颞叶癫癎21例手术治疗分析

目的探讨颞叶癫癎的外科治疗方法及效果.方法 21例颞叶癫癎患者,术前均行EEG、MRI检查,其中6例行PET检查,经定侧定位后,行手术治疗.其中13例行标准前颞叶切除术,5例行病灶切除+致癎灶切除,3例行选择性海马杏仁核切除.术中应用皮层电极或深部电极进行监测;神经导航下海马钙化切除1例.结果术后无明显并发症,均取得满意近期效果.结论海马硬化是颞叶癫癎发生的主要原因;手术是治疗颞叶癫癎的重要手段,且疗效满意.     

PET/CT在非病灶性癫(癎)外科评估中的作用

目的 探索PET/ CT 在癫(癎)外科评估中的作用,更好地利用PET/ CT 以提高癫(癎)外科的治疗水平.方法 总结分析已经进行手术治疗的难治性局灶性癫(癎)46 例.所有病例在术前都经PET/ CT 检查(发作间期),并随访6 ～24 个月.结果 颞叶癫(癎)24 例PET/ CT 阳性,与头皮EEG 结果、MRI 及颅内电极检查结果有高度的一致性;24 例均行颞前叶海马切除术,结果Engel I-II 级者22 例.非颞叶癫(癎)22 例,行致(癎)皮层切除术,15 例达Engel Ⅰ-Ⅱ级.结论 对于颞叶癫(癎)PET/ CT 检查能协助判断侧别.对于非颞叶癫(癎),它可以帮助确定癫(癎)源的范围,指导颅内电极的植入.     

立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的临床研究

目的 探讨立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的有效性,同时评价深部电极记录的发作间歇期痫性放电定位致痫灶的准确性. 方法 选择南方医院神经外科门诊自1998年7月至2003年10月收治的21例顽固性颞叶癫痫患者,行立体定向杏仁核海马毁损术.术中在毁损靶点前后行深部电极记录,统计发作间歇期痫性放电发生频率. 结果 术后随访21例,其中EngelⅠ级6例,Ⅱ级2例,Ⅲ级5例,Ⅳ级3例,Ⅴ级5例.有效者(Ⅰ+Ⅱ+Ⅲ级)13例,无效者(Ⅳ+Ⅴ级)8例,有效率为62％.深部电极记录的发作间歇期痫性放电手术前后的发生频率差异无统计学意义(P＞0.05). 结论 立体定向射频毁损杏仁核海马手术治疗颞叶内侧型癫痫安全有效.深部电极记录的发作间歇期痫性放电定侧价值较高,而定位价值低.     

海马有病损的颞叶内侧癫(癎)手术15例临床分析

目的 探讨海马有病损的颞叶内侧癫(癎)的手术价值.方法 回顾性分析经手术治疗的15例伴有海马病损颞叶内侧癫(癎)患者.均经详细了解发作症状学、附加蝶骨电极的长程视频脑电图及颅脑磁共振等检查;经正规而详尽的术前评估,行前颞叶切除术,术后随访至少半年以上.结果 术后依据Engel分级,显效(Ⅰ级和Ⅱ级)占80.0％ (12/15)、好转(Ⅲ级)占20.0％(3/15)、无效(Ⅳ级)为0.0％.结论 颞叶内侧癫(癎)手术效果确切,是基层医院开展癫(癎)手术的理想选择.     

选择性杏仁核海马切除术治疗颞叶内侧型癫疗效分析

目的探讨选择性杏仁核海马切除术对治疗颞叶内侧型癫的疗效。方法选择颞叶脑电异常与海马硬化同侧病例10例,其中单纯部分性发作继发全身性发作2例,复杂部分性发作5例（3例继发全身性发作）,全身强直-阵挛性发作3例。经颞底海马旁回入路切除杏仁核海马。结果术后病人均恢复良好。所有病例均随访1a以上,6例发作完全缓解（EngelⅠ、Ⅱ级,60%）,2例缓解明显（EngelⅢ级,20%）,1例轻度缓解（EngelⅣ级,10%）,1例病人术后半年自行停药造成癫复发。结论对伴同侧海马硬化的颞叶内侧型癫患者行选择性杏仁核海马切除术（经颞底海马旁回入路）疗效显著,可改善性发作情况。     

Duration of complex partial seizures: an intracranial EEG study

PURPOSE: The dynamics of partial seizures originating from neocortical and mesial temporal regions are thought to differ, yet there are no quantitative comparative studies. The studies reported here investigate the duration of complex partial seizures in these populations using analyses of seizures recorded from intracranial arrays. METHODS: Data were collected from patients undergoing presurgical evaluation with intracranial electrodes. Seizure duration was defined as the time of earliest sustained ictal activity until the termination either in all electrodes (global duration, GD), or at the onset area (focal duration, FD). Patients were divided into three groups: mesial temporal lobe epilepsy (MTLE), neocortical temporal lobe epilepsy (NCTLE), and neocortical extratemporal lobe epilepsy (NCXTLE). RESULTS: Complex partial seizure durations were significantly longer in the MTLE group compared to the NCXTLE group. Median GD for MTLE was 106 s, and for NCXTLE was 78 s. There were no significant differences between seizure durations when comparing MTLE group to NCTLE group, or comparing NCTLE group to NCXTLE group. In the MTLE group, patients with bilateral recording arrays had significantly longer median seizure durations (GD and FD) than those sampled with unilateral arrays. CONCLUSIONS: In this select group of patients there is a significant difference between the duration of complex partial seizures of mesial temporal and neocortical extratemporal origin with mesial temporal complex partial seizures being longer. This may result from a number of possibilities including the bilateral propagation of some mesial temporal seizures and differences in ictal generators of the underlying networks.     

Semiology of hyperkinetic seizures of frontal versus temporal lobe origin

Aims. Hyperkinetic seizures are usually associated with frontal lobe epilepsy. However, some patients have hyperkinetic seizures of temporal lobe origin. The semiological differences in hyperkinetic seizures between frontal and temporal lobe epilepsy have not been well studied. Here, we retrospectively assessed ictal semiology in order to distinguish between hyperkinetic seizures of frontal lobe origin and those of temporal lobe origin. Methods. We retrospectively reviewed data on patients who had undergone surgery for hyperkinetic seizures of temporal or frontal lobe origin and achieved favourable seizure outcomes (Engel Class I) with a minimum postoperative follow‐up of 24 months. We reviewed seizure histories, imaging reports, video‐EEG monitoring data, operative records, and pathological findings. We analysed and compared the hyperkinetic semiology of video‐recorded seizures of temporal lobe origin and those of frontal lobe origin. Results. Forty hyperkinetic seizures in eight patients (seven adult patients and one 12‐year‐old patient) with temporal lobe epilepsy and 45 hyperkinetic seizures in nine patients (eight adult patients and one 16‐year‐old patient) with frontal lobe epilepsy were analysed. Emotional facial expressions (such as fear, laughing, or anger), bilateral forceful elbow flexion, bilateral forceful grasping, facial flushing, and bilateral facial contraction were observed significantly more frequently in seizures of frontal lobe origin. Oroalimentary automatisms, seizures during wakefulness, salivation, and bilateral drop of the corners of the mouth were observed significantly more frequently in seizures of temporal lobe origin. Conclusions. Observation of a number of signs during hyperkinetic manifestations may help to predict whether a seizure originates from the frontal lobe or the temporal lobe.     

Comparison of depth and subdural electrodes in recording temporal lobe seizures

Intracranial EEG recording is often required to identify an area of the brain for resective surgery for intractable epilepsy. We simultaneously compared bilaterally placed depth and limited subdural electrode EEG to determine the most effective method of recording seizures from the temporal lobes. Localized complex partial seizures usually appeared earlier in hippocampal depth electrodes and spread later to subdural recording sites. In 3 patients, hippocampal recordings showed localized seizure origin but subdural recording was nonlocalizing due to rapid bilateral seizure propagation. In 1 patient with nonlocalized seizures presumably of extratemporal origin, subdural electrodes incorrectly lateralized seizure origin to a temporal lobe. Auras and subclinical seizures detected by depth electrode recording were often not evident with subdural electrodes. We conclude that EEG recording with hippocampal depth electrodes correctly identifies and lateralizes temporal lobe seizures more often than with limited subdural electrodes.     

Bitemporal form of partial reading epilepsy: Further evidence for an idiopathic localization-related syndrome

Idiopathic partial reading epilepsy (RE) is a rare syndrome. We report the clinical and electroencephalographic characteristics of two right-handed patients with the following: reading-induced independent bilateral temporal lobe seizures, accompanied by alexia in left (dominant) sided seizures recorded on video-EEG (electroencephalography); subclinical activation over left posterior temporal and occipital electrodes during reading; no spontaneous seizure and no other trigger than reading; onset in adolescence; and history of varying resistance to treatment. Bilateral independent temporal lobe reflex seizures are part of the clinical spectrum of RE. It may result from hyperexcitability of bilateral cortical networks involved in the early steps of the reading process.     

Effects of Sleep and Sleep Stage on Epileptic and Nonepileptic Seizures

Summary: Purpose: Previous studies of patients with epilepsy and animal models of epilepsy suggest that sleep increases the frequency, duration, and secondary generalization of seizures. This information is, however, incomplete.
Methods: We retrospectively examined video-EEG monitoring reports from our comprehensive epilepsy center. We recorded seizure type, site of onset (for partial seizures), sleep state at onset, and whether partial seizures secondarily generalized. Seizures arising from sleep were then reviewed to determine sleep state.
Results: We analyzed 1,116 seizures in 188 patients. Thirty-five percent of complex partial seizures (CPSs) starting during sleep underwent secondary generalization compared with 18% in wakefulness (p < 0.0001). Frontal lobe CPSs secondarily generalized at equal rates during sleep (22%) and wakefulness (20%), but temporal lobe CPSs generalized much more frequently during sleep (45%) than in wakefulness (19%; p < 0,0001). Frontal lobe seizures were more likely to occur during sleep (37%) than were temporal lobe seizures (26%; p = 0.0068). CPSs were more frequent in stages 1 and 2 and occurred rarely during REM. Seizures starting during slow-wave sleep were significantly longer than seizures starting during wakefulness or stage 2 sleep. Psychogenic nonepileptic seizures (PNESs) were rare between midnight and 6 a.m. and never occurred during sleep.
Conclusions: Sleep has a pronounced effect on secondary generalization of partial seizures, especially those of temporal lobe origin. Frontal lobe seizures occur more often during sleep than do temporal lobe seizures, and occurrence during sleep helps to distinguish PNESs from CPSs.     

New-onset mesial temporal lobe epilepsy in a 90-year-old: clinical and EEG features

Although there is a peak in the incidence of epilepsy in the elderly compared with the general population, complex partial seizures represent less than 15% of the seizure types reported. We report on a 92-year-old woman with a 2-year history of daily complex partial seizures. Prolonged video/EEG recording showed bilateral anterior mesial temporal interictal spikes, which predominated on the left, and two typical seizures arising from the left temporal area. Cranial MRI scanning showed multiple lacunar infarcts without temporal lobe involvement or mesial temporal atrophy. Our case appears to be oldest patient in the literature with newly diagnosed mesial temporal lobe epilepsy confirmed by video/EEG recording.     

Intracranial EEG in temporal lobe epilepsy.

Intracranial EEG monitoring before epilepsy surgery, while becoming less commonly performed in patients with unilateral mesial temporal lobe epilepsy, is still widely used when bilateral independent temporal lobe seizures are suspected or when extratemporal foci cannot be ruled out by noninvasive means. Additionally, many epilepsy centers are reporting excellent surgical outcome in patients with neocortical temporal lobe epilepsy, when resections are guided by intracranial EEG studies. This article reviews the indications, technical aspects, risks, and interpretation of intracranial EEG in patients with temporal lobe seizures. It also considers intracranial EEG features predictive of surgical outcome.     

Psychomotor epilepsy and psychosis

The EEG findings in waking, sleep, and sphenoidal electrode recordings in 96 patients with partial epileptic seizures with complex symptoms, who, after a median interval of 18 years developed paranoid/hallucinatory psychosis, were compared with the findings from a group of patients without psychosis, who had had the same type of epilepsy in median 24 years. There were no significant differences between the two groups with regard to median age at onset of epilepsy or complex partial seizures, age, or duration of epilepsy at time of examination. the psychotic patients had a significant preponderance of temporal medio-basal spike foci, recorded on the sphenoidal electrode, indicating deep temporal lobe dysfunction as an important factor in the pathogenesis of psychosis. A significant higher frequency of bilateral and multiple spike foci, together with a significant frequency of slow-wave admixture to the waking background EEG activity, indicated more extensive and severe epileptogenic lesions in the psychotic patients. There was no correlation between psychosis and unilateral EEG foci in either temporal lobe.     

Cardiac rhythm during temporal lobe seizures.

We studied the neuroanatomic correlates of ictal tachycardia in 27 seizures from five patients with unilateral temporal lobe epilepsy being evaluated with bilateral temporal lobe depth electrodes and orbitofrontal subdural electrodes. There were 11 complex partial seizures, three simple partial seizures, and 13 subclinical seizures. For all seizures, heart rate (HR) increased in a graded fashion as new cortical regions anywhere in the brain were recruited into the seizure. HR plateaued at the new level despite EEG frequency changes until the next region became involved. Increases in HR did not correlate with increased duration of seizures but rather with volume of brain involved. Restricted amygdaloid seizure activity was generally insufficient to alter HR. We conclude that the amygdala has a limited role in modulating HR during seizures, and ictal tachycardia depends principally on the volume of cerebral structures recruited into a seizure.     

Outcome after temporal lobectomy in bilateral temporal lobe epilepsy

We determined how noninvasive presurgical data relate to prognosis after temporal lobectomy in patients with independent bilateral temporal lobe (IBTL) complex partial seizures on the intracranial electroencephalogram (EEG). Between 1986 and 1994, 28 patients had IBTL seizures on intracranial EEG. Fifteen of these 28 patients underwent temporal lobectomy and 13 were not offered surgery. Of the 15 patients who had surgery, 10 patients became seizure-free. Magnetic resonance imaging (MRI) and the Wada test were the only variables associated with a seizure-free outcome. Seven of 10 seizure-free patients had a lateralized Wada result or the presence of unilateral hippocampal sclerosis, whereas none of the patients with persistent seizures had either of these findings. Variables not found to be predictive of a seizure-free outcome included location of scalp interictal spikes, degree of seizure-onset laterality, presence of early epilepsy risk factor, duration of epilepsy, and full-scale intelligence quotient. We conclude that MRI and the Wada test provide information of prognostic value in patients with bilateral temporal seizures independent of intracranial EEG data.