术前头皮长程视频脑电图表现与颞叶癫痫手术预后的关系

目的 探讨术前头皮长程视频脑电图(VEEG)发作间期放电、发作期起始侧别与颞叶癫痫(TLE)患者手术预后的关系.方法 回顾性分析75例颞叶癫痫手术治疗患者的临床资料.患者术后经过1～9年的随访,根据手术后有、无癫痫发作将患者分为发作组和无发作组.另外按两组患者中术前头皮脑电图发作间期放电及发作期起始侧别分组,比较各组患...     

视频脑电图结合磁共振扫描对颞叶癫痫术前定位的探讨

目的 探讨视频脑电图及磁共振扫描对颢叶癫痫术前定位的准确性.方法 回顾分析146例颞叶癫痫病例,术前均行长程视频脑电图(V/EEG)监测及磁共振扫描(MRI),发作时V/EEG所示的痫样放电部位与MRI检查所发现的病变同侧时,将此侧颞叶作为癫痫灶颞叶;MRI未见异常,则根据三次以上发作时V/EEG定侧.所有患者经术中皮层脑电图和深部脑电监测后,行前颞叶切除术.结果 术中皮层脑电图及深部脑电监测均发现有痫样放电,与术前V/EEG监测吻合.术后102例(70%)癫痫发作完全消失,显著改善35例(24%),良好6例(4%),无改善3例(2%).结论 V/EEG结合MRI对颞叶癫痫术前能进行准确定位.     

术中皮层脑电图在颞叶癫痫手术中的应用

目的 探讨术中皮层脑电图(ECoG)在颢叶癫痫手术中的应用价值.方法 回顾性分析105例前颞叶切除手术患者的临床资料与ECoG的监测结果,统计对ECoG的影响因素及其对手术疗效的影响.结果 术前ECoG平均监测时间为72 min,结果显示:无异常11例、颢叶或前颞叶局限性放电73例、广泛痫性放电21例;术后ECoG平均监测时间为38 min,结果显示:无异常91例、颞叶后部痫性放电9例、广泛痫性放电5例.年龄与术前EcoG结果无明显相关性;而病程＜5年者术前EcoG痫性放电局限于前颞叶的比率较高,达到83.3%,且与另外两组差异有统计学意义.有6例(5.7%)根据术后ECoG结果行颞叶皮层后部扩大切除.术前ECoG显示痫性放电局限于前颞叶和术后ECoG正常与其他同期结果间的手术疗效差异有统计学意义,提示术后无癫痫发作.结论 颞叶癫痫患者ECoG监测可发现70%的痫波局限于前颞区,术前和术后ECoG监测结果可用于初步判断手术疗效,ECoG监测对颞叶癫痫手术具有一定的应用价值.     

颞叶癫痫术后脑电图转归的影响因素与疗效分析

目的分析颞叶癫痫手术后脑电图不同转归的影响因素及与疗效的关系。方法回顾性分析124例行手术治疗的颞叶癫痫患者术后脑电图,根据脑电图的转归将病例分为两组,A组为术后脑电图正常;B组为术后脑电图仍存在癫痫样放电,并分析不同脑电图转归与癫痫病程、首发年龄、术前脑电图痫样放电分布范围及术后疗效的关系。结果 A组占70.97%(88/124),B组占29.03%(36/124),两组患者术前癫痫病程及首发年龄间无统计学差异(P均0.05),B组患者术前脑电图异常分布较A组广泛(55.56%vs.25.00%,P0.01)。A组术后无发作率为92.05%(81/88),B组无发作率为61.11%(22/36),两组间有统计学差异(P0.01)。结论颞叶癫痫术前异常脑电图分布范围影响术后脑电图转归,术后复查脑电图仍有异常者其术后总体疗效要差,提示更需要加强患者的药物巩固治疗。     

颞叶占位性病变伴癫痫患者的手术治疗研究

目的探讨颞叶占位性病变伴癫痫患者手术治疗的疗效,分析多种致痫灶定位技术的联合应用对手术疗效的影响。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料,其中囊性占位7例,海绵状血管瘤6例,胶质瘤16例,其他病变2例;应用MRI、视频脑电图、脑磁图行致痫灶定位,术中应用皮质脑电图再次精确致痫灶范围后行前颞叶联合海马切除术,术后随访评估疗效。结果长程VEEG监测中,20例患者均有惯常发作和发作间期痫样放电,14例(14/20)患者发作间期痫样放电位于单侧颞叶及海马区,其中合并同侧额区放电5例。6例(6/20)患者发作间期放电位于双侧颞叶,其中合并单侧额区放电2例。8例(8/20)起源于左侧颞叶及海马区,12例(12/20)起源于右侧。MEG检查20例患者发作间歇期皆有痫样放电,检出率为100%,17例(17/20)患者单侧颞叶放电,其中合并同侧额区放电8例;3例(3/20)患者双颞放电。术后随访12~24个月:16例患者Ⅰ级,3例Ⅱ级,1例Ⅲ级,手术有效率100%,效果良好率95%。结论颞叶占位性病变伴癫痫患者的手术治疗疗效好,多种致痫灶定位技术的联合应用可提高手术疗效并有效减少术后并发症。     

难治性颞叶癫痫的手术治疗方式及其疗效研究

目的 探讨难治性颞叶癫痫的临床特点、术前评估方法、手术治疗方式及其疗效。方法 105例难治性颞叶癫痫患者术前行头部CT及MRI检查,同时加行双侧海马磁共振波谱分析(MRS);并均行长程视频脑电图检查。根据患者的术前临床发作特点、影像学和长程视频脑电图检查结果,在术中皮层脑电图监测下行手术治疗。术后随访患者1年以上,观察手术的疗效。结果 本组患者中,48例海马硬化患者行前颞叶切除术(包括大部分海马及杏仁核);另外57例有其他病灶的患者先行病灶切除术,复查皮层脑电图其中23例患者仍有异常放电,对这23例患者加行前颞叶切除术(包括大部分海马及杏仁核),前颞叶切除后有5例患者仍有异常放电,予以皮层热灼术。手术疗效:术后80例患者的癫痫发作完全消失,13例患者较术前明显缓解,12例患者无明显变化;总有效率为88. 6%,优良率为76. 2%。结论 颞叶癫痫的发作形式有一定的临床定位价值,如果患者的神经影像学和视频脑电图检查结果一致,则强烈建议手术治疗。手术一定要在皮层脑电图监测下进行;同时术中在切除颞叶病变后,应根据皮层脑电图监测结果加行前颞叶切除术,必要时再加行皮层热灼术,以解决双重病理现象。     

成人颞叶癫痫发作间期CT灌注成像的变化

目的探讨成人颞叶癫痫发作间期单侧和双侧痫性放电CT灌注成像的变化。方法将21例颞叶癫痫患者根据视频脑电图监测分为单侧痫性放电组11例、双侧痫性放电组10例,两组患者均在发作间期行CT灌注成像检查,计算每例患者双侧颞叶脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit ti me,MTT)的灌注参数,并比较每组患者颞叶CBF、CBV、MTT以及两组的CBF、CBV、MTT不对称指数(asymmetry index,AI)。结果21例患者头颅CT平扫均无异常,每组患者发作间期双侧颞叶CBF、CBV、MTT差异无统计学意义(P>0.05),两组患者CBF不对称指数差异有统计学意义(t=2.269,P=0.035),CBV和MTT不对称指数差异无统计学意义(P>0.05),在单侧痫性放电组中,痫性放电侧颞叶脑血流量较对侧有所减低,但比较差异无统计学意义(t=-2.093,P=0.063)。结论颞叶癫痫CT灌注成像显示颞叶区发作间期单侧痫性放电较双侧痫性放电脑血流量不对称。     

安定抑制试验在颞叶癫痫病灶定位中的临床应用研究

目的：颞叶癫痫患者在脑电图（ＥＥＧ）描记过程中,常常表现为双侧颞叶痫样放电（多数为同步性放电,少数为不同步放电）。在这种情况下,要鉴别原发性（即病灶侧）同步放电和继发性同步放电是一个难题,这也是手术治疗颞叶癫痫必须解决的问题,我们在实践中摸索出安定抑制试验来解决了这个问题。方法：在美解眠诱发过程中,当双侧蝶骨电极出现明显的痫样放电或是出现癫痫发作时,立即停注美解眠,再缓慢静脉注射安定１０～２０ｍｇ并继续描记ＥＥＧ。结果：４０例双侧痫样放电的颞叶癫痫患者,经该试验检查后都确定了痫灶,在手术中,皮层脑电图（ＥＣＯＧ）均描记出明显的痫样放电,痫灶切除后ＥＣＯＧ放电消失或明显减少。病理检查发现其中的１６例有病理改变,术后经过半年至７年的随访,疗效评价为优３６例,良４例。结论安定抑制试验是一个能准确鉴别出颞叶癫痫病灶的新方法     

35例颞叶癫痫临床特征与脑电图分析

目的探讨颞叶癫痫(temporal lobe epilepsy TLE),临床特征和脑电图(electroencephalogram,EEG)的特点。方法对已确诊的35例TLE患者均行视频脑电图(Video-VEEG)检查,并结合临床症状进行分析。结果 35例TLE患者脑电图中,1例正常,5例非特异性改变,29例有痫性放电,其中左侧颞叶放电12例,右侧颞叶放电8例,双侧颞叶放电9例。监测过程中4例出现临床发作。EEG癫痫波多分布于一侧颞区。临床症状中以继发性全身强直-阵挛发作占最多。结论颞叶癫痫临床特征及颞区痫性放电对TLE诊断有重要作用;VEEG对提高TLE的诊断和定位有重要意义。     

27例学龄前难治性颞叶癫痫患儿临床报道

目的探讨学龄前难治性颞叶癫痫患儿影像学、电生理特点及手术方法和疗效。方法回顾性分析解放军联勤保障部队第九八八医院神经外科中心自2014年6月至2019年1月行手术治疗的27例学龄前难治性颞叶癫痫患儿资料,术前评估结合临床发作表现,MRI、磁共振波谱分析(MRS)、正电子发射断层扫描(PET-CT)等影像资料,以及发作间期和发作期视频脑电图(VEEG)资料;术中应用皮层脑电图(ECoG)与深部电极监测定位异常放电区域,指导手术切除致痫灶范围。术后采用Engel分级评估疗效。结果27例患儿均有典型颞叶癫痫临床表现,MRI发现一侧颞叶及海马异常信号影,发作间期及发作期VEEG提示异常放电起始于一侧额颞部。术中ECoG及深部电极监测均发现颞叶明显持续或阵发性尖波、棘波、棘慢复合波等癫痫样放电。27例患儿均采用标准前颞叶+病灶切除+周边异常放电颞叶皮质扩大切除术,其中2例患儿切除部分岛叶长回及额盖皮质热灼处理。随访6个月,EngelⅠ级患儿22例,EngelⅡ级患儿3例,EngelⅢ级患儿2例。结论早期手术、术中ECoG与深部电极联合监测下适度扩大切除范围是改善学龄前难治性颞叶癫痫患儿手术疗效的关键因素。     

睡眠癲痫发作时血清促肾上腺皮质激素和皮质醇的变化

目的探讨睡眠癫痫患者临床发作时血清促肾上腺皮质激素（adrenoconicotropic hormone,ACTH）和皮质醇的变化及其与脑电波变化之间的联系。方法采用24导video—EEG对睡眠癫痫患者进行脑电监测,并对其发作前瞬时的EEG进行分析,采用化学发光免疫法在清醒时、睡眠时、发作前瞬间、发作时和发作后的5个时间点测定血清中ACTH和皮质醇的浓度。在36例睡眠癫痫患者中,28例为自然发作,8例为贝美格诱发发作。用11例假性心因性癫痫发作患者作为对照组。结果睡眠癫痫发作前、中、后血清ACTH和皮质醇的浓度有显著差异（P〈0．001）,发作前瞬间降低,发作时升高,发作后明显升高;假性癫痫发作对照组的血清ACTH和皮质醇浓度在发作时无明显变化（P〉0．05）;贝美格诱发发作组与自然发作组间ACTH和皮质醇比较无显著差异（P〉0．05）。结论睡眠癫痫患者血清ACTH和皮质醇与癫痫发作前和发作时的脑电变化有密切关系。     

Noninvasive CBV Measurements During Epilepsy Using Multichannel NIRS

Purpose : Cerebral blood volume (CBV) was measured noninvasively during an epileptic seizure to localize the focus using near-infrared spectroscopy (NIRS).
Methods : In nine patients with intractable epilepsy (eight temporal and one parietal lobe), seizures were induced by bemegride. CBV was measured with an 8-channel NIRS (1 Hz). The ictal single-photon-emission computed tomography (SPECT) also was evaluated.
Results : In all of the cases, CBV increased for 20–50 s on the same side as the focus within 2 s after the onset of seizures, compatible with the EEG and ictal SPECT findings.
Conclusions : NIRS is valid for the localization of the focus in epilepsy.     

Interictal and ictal activity recorded with subdural electrodes during preoperative evaluation for surgical treatment of epilepsy

A total of 94 subdural strip electrodes were implanted in 22 patients during preoperative EEG evaluation for surgery of epilepsy. Eighteen patients had temporal lobe seizure onset, three had frontal lobe seizure onset, and one had occipital lobe seizure onset. Most electrodes (total, 83) were localized over the temporal lobe cortex, but in four cases additional strip electrodes (total, 11) covered the frontal, parietal, and occipital lobe cortexes. The electrodes were left in place for up to 28 days. No complications occurred. Interictally, focal spiking was recorded subtemporally, mostly without being seen in electrodes recording from the lateral temporal cortex. In three patients studied with simultaneous subdural and sphenoidal wire electrodes, spiking recorded from subdural electrodes was often not seen in the sphenoidal recording. There were 151 seizures recorded (with or without simultaneous video monitoring). The mean number of seizures per patient was 6.7 (range, 0–21). The seizures were classified as having focal (80 seizures) or local (71 seizures) onset. It is concluded that subdural electrodes are safe and have a sufficient selectivity with regard to localization of interictal spiking and seizure onset in patients with mesial temporal epileptic lesions. In such cases, electrodes have to be placed subtemporally. Other cortical areas may also be explored with these electrodes.     

Ictal scalp EEG recording during sleep and wakefulness: diagnostic implications for seizure localization and lateralization

To determine the localizing value of electroencephalography (EEG) for seizures during sleep versus seizures during wakefulness, we compared scalp EEG for 58 seizures that occurred during sleep with 76 seizures during wake in 28 consecutive patients with temporal lobe epilepsy. Regression analysis showed that seizures during sleep are 2.5 times more likely to have focal EEG onset (p = 0.01) and 4 times more likely to correctly localize seizure onset (p = 0.04) than seizures during wake. EEG seizure onset preceded clinical onset by a longer duration in sleep seizures (mean, 4.69 s) than in wake seizures (mean, 1.23 s; p < 0.01). Sleep seizures showed fewer artifacts, but the difference was not significant (p = 0.07). For temporal lobectomy candidates undergoing video-EEG monitoring, the recording of seizures during sleep may be favored.     

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.     

Sphenoidal electrodes THEIR USE AND VALUE IN THE ELECTROENCEPHALOGRAPHIC INVESTIGATION OF COMPLEX PARTIAL EPILEPSY

The diagnostic value of sphenoidal electrode EEG recordings in patients with seizures characteristic for epilepsy with complex partial symptomatology was assessed in a study comprising 404 patients; 71.3% of the patients had seizures with automatisms and amnesia, and 28.7% had psychic seizures with subjective phenomena such as hallucinations and illusions. A total of 59.6% of the patients had diagnostic EEG changes in routine waking or sleep EEG. In sphenoidal EEG recording including thiopenthone activation, diagnostic changes were found in 40.5% of the patients without specific changes in waking or sleep EEG, the chance of a positive finding being more than five times higher in patients with automatisms than patients with psychic seizures. Apart from cases where surgical treatment of temporal lobe epilepsy is considered, sphenoidal electrode EEG recording, including intravenous thiopenthone activation, should be performed in patients with seizure phenomena raising suspicion of epilepsy with complex partial symptomatology but where waking and sleep EEGs fail to demonstrate specific abnormalities.     

Hyperreligiosity in temporal lobe epilepsy: redefining the relationship

Seventy-six subjects with the primary diagnosis of complex partial seizures with a unilateral temporal lobe focus were examined for the presence of hyperreligiosity. Fifty-one subjects had a left temporal lobe seizure focus and 25 had a right temporal lobe seizure focus. In addition to the temporal lobe epilepsy (TLE) groups, two reference groups were also examined. The first consisted of 31 subjects with primary generalized seizures. The second control group consisted of 27 subjects with documented pseudoseizures and no objective evidence of recurrent epileptic seizures. In all cases, the documentation of seizures or pseudoseizures as well as the localization of the seizure focus was accomplished through simultaneous videotaped recording of the 16-channel scalp EEG tracing and the concurrent overt behavior during the ictal phase. The results of this study fail to support the hypothesis that individuals with TLE are characteristically hyperreligious during the interictal state. There were no significant group differences between the left vs. the right TLE groups, nor were there any significant group differences between the two TLE groups vs. the two comparison groups.     

SECTION D: NEUROSURGERY & NEUROPATHOLOGY

Comparison of surgical and medical treatment for partial epilepsy. Medical and social implications of the treatment
Procedures in Pediatric Epilepsy Surgery
The possible need for intra-cranial EEG in surgery for temporal lobe epilepsy
Consistency of lateralisation in intracranial record-ings of seizures of temporal lobe origin
Comparison of lateralising capability of 99Tc^m HM-PAO-SPECT, neuropsychology, interictal and ictal EEG in the pre-surgical evaluation of patients with intractable epilepsy
Convergence of CT/MRI, "FDG-PET, intracarotid amobarbital procedure and D.EEG in presurgical evaluation of refractory partial epilepsy
Surgery for epilepsy in the United Kingdom
Anterior 2/3 callosotomy for the treatment of in-tractable epilepsy
Pre-surgical EEG evaluation
A simplified technique for epidural recording of epi-leptiform activity and seizure patterns
Discrepancy between interictal and ictal EEG-find-ings - the use of subdural electrodes may solve the problem
Temporal mesiolimbic versus temporal neocortical complex partial seizures; electroclinical correlates recorded by combined depth and subdural electrodes
Verifying electrical dipole localization in patients with epilepsy undergoing depth EEG recordings in the presurgical evaluation of intractable epilepsy
A current dipole tracing method locating interictal epileptiform activity in patients with focal epilepsy
PET-studies on distribution of glia in patients with focal epilepsy
Relationship of pre-operative neuropsychological test to the sodium amytal test - results on an empiri-cal study
Amygdalohippocampectomy in complex partial epi-lepsy     

急性氯化铁癫痫模型大鼠美解眠诱发放电的实验研究

目的 探讨急性氯化铁癫痫模型大鼠在发作间期美解眠诱发试验中的放电特征.方法 给予SD大鼠头颅额、顶、枕部铺设硬膜外电极6枚,用立体定向方法在大鼠感觉运动皮质区注入氯化铁溶液,建立急性癫痫模型,记录脑电24小时,观察在发作间期给予急性氯化铁癫痫模型大鼠腹腔注射美解眠后诱发癫痫发作的脑电情况.结果 美解眠诱发试验中,出现两种不同类型的癫痫发作期脑电,其中一种与急性氯化铁模型的发作期放电相同,另一种与美解眠自身所致癫痫的发作期放电相似.结论 急性氯化铁癫痫模型大鼠在美解眠诱发试验中能够产生原有癫痫发作,但是假阳性率较高;氯化铁致痫大鼠对美解眠的反应性较正常大鼠高.     

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.