癫痫灶术前定位进展

癫痫是神经内外科的常见疾患，严重影响患者的生活质量。近年来，随着电生理学及神经影像学的飞速发展，EEG、CT、MRI、MEG、SPECT、PET等技术的应用，为癫痫灶的定位诊断提供了有力手段。本文结合各种检查方法的应用特点，综述癫痫灶的术前定位进展。     

难治性癫痫的术前定位及联合手术24例临床分析

目的探讨难治性癫痫患者的术前定位及手术治疗。方法对24例难治性癫痫患者在进行术前综合定位的基础上实施联合手术治疗。结果术后随访半年到3年,手术后达到良好以上的21例,占87.5%。术后有9例出现急性发作,其中3例长期效果差。结论影像学结果检查阳性者手术效果好。脑磁图对难治性癫痫的定位很有帮助。根据病情将前颞叶或(及)海马切除、软化灶切除、萎缩灶切除,胼胝体切开术,皮层热灼术等联合进行,有助于改善预后。术后出现急性发作者长期效果差。     

难治性癫痫致痫灶的术前常用评估方法及有效性分析

目的 分析难治性癫痫致痫灶的术前常用评估方法的定位价值,为术前评估方法的合理选择提供依据。方法 回顾性分析2011年9月至2013年10月手术治疗的76例难治性癫痫的临床资料,分别评估症状学、头皮及颅内脑电图、影像学检查在术前致痫灶定位中的有效性。结果 分别有88.1%、44.7%、82.9%的病人通过临床症状学、头颅MRI、头皮脑电图监测可获得一定价值的定侧或定位信息;在难治性颞叶内侧癫痫中,手术侧海马头MRS NAA/（Cr+Cho）比值较对侧明显降低（P<0.05）,当双侧海马头NAA/（Cr+Cho）比值的不对称指数>0.08时,判断NAA/（Cr+Cho）比值较小一侧为致痫灶所在侧别的准确率更高。19例头颅MRI阴性并接受PET-CT检查的病人中,68.4%可获得一定价值的定侧或定位信息;仍有68.4%的病例需要通过颅内脑电图监测来进一步明确致痫灶的部位及范围。结论 临床症状学分析及头皮脑电图监测对颅内电极的植入及致痫灶切除术有着重要的参考价值;MRI及MRS检查在难治性颞叶内侧癫痫的术前评估中存在一定的参考价值;PET-CT对于头颅MRI检查阴性的病例在癫痫手术中仍有着一定的参考价值;颅内脑电图监测对于致痫灶的判断及癫痫手术切除范围的限定仍有着决定性的意义。     

SPECT、EEG、MRI在癫痫发作期发作间期对癫痫灶的定位价值

目的:顽固性癫痫Г-刀治疗的关键在于定位,比较15例顽固性癫痫SPECT(single photon emission compu-ted tomography,SPECT)EEG,MRI在癫痫发作期、发作间期对癫痫灶的定位价值。方法:发作间期做SPECT、EEG、MRI,而后用0.25％美解眠诱发癫痫临床下发作记录发作期SPECT。结果:发作间期致痫灶SPECT 10人,EEG7人,MRI 3人;发作期SPECT 3人。结论:发作间期癫痫灶检出率SPEC:T66.67％,EEG44.67％,MRI 20％;发作期为20％。三项检查分别从代谢、电活动和结构对癫痫灶进行定位。SPECT阳性检出率最高;EEG在癫痫分类和定侧(左或右半球)具有优势;而MRI在癫痫灶定性方面有帮助。三者相结合可提高癫痫灶的准确性。     

同步EEG-fMRI的研究方法及其在难治性癫痫致痫灶术前定位中的应用

20世纪80年代起,由于术前评估手段的快速发展和临床的广泛应用,通过手术治疗难治性癫痫的例数显著增加。对难治性癫痫致痫灶的术前精确定位是手术能否成功的关键;近年来,同步脑电图-功能性磁共振(Simultaneous EEG-fMRI)作为一种无创的术前定位方法逐渐应用于临床,在进行功能性磁共振扫描的同时描记脑电数据,根据EEG出现癫痫波的时间点作为时间相关曲线对fMRI数据进行分析,通过测定发作间期痫样放电的血流动力学效应来定位致痫灶,可以将解剖定位与功能定位相结合,为临床医师提供一种新的、精确度较高的定位方法。     

难治性癫痫的偶极子定位手术治疗

目的：探讨利用偶极子三维颅内癫痫病灶定位系统对难治性癫痫病患者致痫灶定位，进行外科手术治疗的效果。方法：对1999年8月至2001年6月在我院实施的259例难治性癫痫患者运用偶极子三维颅内癫痫病灶定位系统对难治癫痫患者致痫灶进行术前精确定位，指导采用相应多种方式手术治疗，并探讨其疗效及随访结果。结果：随访6-22月者180例，疗效满意112例，显著改善（发作减少75%以上）36例，良好（发作减少50%以上）22例，疗效差10例。总有效率为94%。显效率82%，未发现任何远期功能损害。结论：偶极子三维颅内癫痫病灶定位系统是目前用于明确癫痫病灶定位较为先进的方法，准确指导手术，可明显提高手术效果，并减少并发症的产生。     

非病灶性癫痫致痫灶EEG、fMRI、PET定位及手术治疗的初步研究

目的探讨非病灶性癫痫(non-lesionalepilepsy,NLE)致痫灶功能定位和手术治疗策略。方法在术前综合评估的基础上,联合应用EEG、fMRI、PET等确定非病灶性致痫灶,采用显微痫灶切除、多处软脑膜下横切除术、胼胝体前部潜行切开术、选择性前颞叶切除术和联合手术以及立体定向脑核团毁损术等微创方式治疗37例NLE,随访复查,评价临床效果。结果37例NLE致痫灶定位情况EEG及PET阳性发现均为27例(72.97%),fMRI阳性30例(81.08%);其中三者均为阳性19例,三者中仅二者阳性12例,三者中仅一者阳性6例,除4例定位不一致外,余均确切定位。术后近期内1例出现一过性肢体肌力下降,余病例均无并发症。随访12~31个月,按Engle标准对手术疗效进行判断,Ⅰ级24例(64.9%),Ⅱ级7例(18.9%),Ⅲ级4例(10.8%),Ⅳ级2例(5.4%),手术总有效率为94.6%。手术前后神经心理各项评估及智商比较无统计学差异(P>0.05);31例(83.78%)病人生活质量改善。结论术前联合应用EEG、fMRI、PET等对NLE致痫灶能进行准确的功能定位,根据临床特点和术前定位情况采用不同的手术方式是治疗NLE的有效途径。     

功能显像技术在难治性癫痫致痫灶定位中的研究进展

准确的致痫灶定位一直是困扰癫痫外科医生的难题。近年来,各种成像技术的广泛应用和不断发展,尤其是功能显像技术的发展,为致痫灶的定位提供了更有效、更准确的定位方法。该文将常用的功能显像技术在难治性癫痫研究中的现状和进展作一综述。     

PET、EEG对癫痫源灶的定位价值

我院从 1 995年 5月～ 1 997年 1 0月收治了 40 0余例癫痫病人 ,本组随机选择了 1 996年 1 0月～1 997年 1 0月间 1 0 0例均行 EEG、BEAM、PET、MRI/CT检查癫痫病人 ,重点对 PET、EEG进行比较 ,探讨脑电生理学与功能性显像对癫痫灶定位的临床价值。对象与方法一般资料 :本组 1 0 0例癫痫患者 ,男性 60例 ;女性 40例 ,平均病程 7.3年 (3～ 2 2年 ) ,均在常规检查的同时做脑电图 (EEG)、脑电地形图 (BEAM)、磁共振成像或 CT扫描 ,正电子计算机断层扫描(PET)。癫痫发作类型和频率 :发作类型依据 1 985年国内和 1 989年国际分类为…     

磁共振波谱分析在难治性颞叶癫痫术前病灶综合定位中的应用研究

目的 初步探讨磁共振波谱分析(proton magnetic resonance spectroscopy,1HMRS)在难治性颞叶癫痫病灶定位中的意义.方法 采用PHLIPHS 3.0 T磁共振设备,PRESS CSI序列,对15例难治性癫痫患者和15例年龄、性别与之配对的健康志愿者分别取双侧海马40 mm×20 mm×10 mm大小区域进行多体素MRS分析,获得NAA、Cho、Cr的峰下面积,以颅内电极和术后病理为标准,探讨MRS在难治性癫痫患者病灶定位中的意义.结果 15例谱线基线稳定,信噪比较好;13例癫痫患者1 HMRS结果与正常对照组测值平均值比较发现异常,定位信息与颅内电极和病理符合.结论 多体素短回波1HMRS(PRESS序列)可以发现常规MRI阴性的TLE患者海马区脑组织代谢的异常,对颞叶癫痫术前的病灶定位有较大意义.     

ICA decomposition of EEG signal for fMRI processing in epilepsy

In this study, we introduce a new approach to process simultaneous Electroencephalography and functional Magnetic Resonance Imaging (EEG‐fMRI) data in epilepsy. The method is based on the decomposition of the EEG signal using independent component analysis (ICA) and the usage of the relevant components' time courses to define the event related model necessary to find the regions exhibiting fMRI signal changes related to interictal activity. This approach achieves a natural data‐driven differentiation of the role of distinct types of interictal activity with different amplitudes and durations in the epileptogenic process. Agreement between the conventional method and this new approach was obtained in 6 out of 9 patients that had interictal activity inside the scanner. In all cases, the maximum Z‐score was greater in the fMRI studies based on ICA component method and the extent of activation was increased in 5 out of the 6 cases in which overlap was found. Furthermore, the three cases where an agreement was not found were those in which no significant activation was found at all using the conventional approach. Hum Brain Mapp 2009. © 2009 Wiley‐Liss, Inc.     

Successful hemispherotomy in two refractory epilepsy patients with cerebral hemiatrophy and contralateral EEG abnormalities

We describe two cases of refractory epilepsy with cerebral hemiatrophy and contralateral electroencephalographic (EEG) abnormalities, in which hemispherotomy of the atrophic hemisphere effectively controlled seizures. Case 1 was a 5-year-1-month-old girl with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm. Magnetic resonance imaging showed left porencephaly corresponding to a left middle cerebral artery infarction. Case 2 was a 3-year-8-month-old boy with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm due to atrophy of the left cerebral hemisphere after septic meningitis. Both patients had right hemiparesis and was incapable of pinching by the right hand. Contralateral interictal and ictal EEG abnormalities were observed. Interictal ^99mTc-ethyl cysteinate dimer (^99mTc-ECD) single photon emission computed tomography (SPECT) showed hypoperfusion and ictal ^99mTc-ECD-SPECT showed hyperperfusion within the left cerebral hemisphere. Left hemispherotomy was performed. Cases 1 and 2 remained seizure-free at the last follow-up 18?months and 15?months, respectively, after surgery, and contralateral interictal EEG abnormalities disappeared. In patients with cerebral hemiatrophy and contralateral EEG abnormalities, epilepsy surgery may be considered when the laterality of seizure semiology, functional imaging findings and motor deficits were concordant with the atrophic side. Ictal SPECT is effective to confirm the epileptogenic hemisphere.     

Resting-state fMRI studies in epilepsy

Epilepsy is a disease characterized by abnormal spontaneous activity in the brain.Resting-state functional magnetic resonance imaging(RS-fMRI) is a powerful technique for exploring this activity.With good spatial and temporal resolution,RS-fMRI is a promising approach for accurate localization of the focus of seizure activity.Although simultaneous electroencephalogram-fMRI has been performed with patients in the resting state,most studies focused on activation.This mini-review focuses on RS-fMRI alone,including its computational methods and its application to epilepsy.     

fMRI辅助神经导航技术结合术中脑电监测在癫痫外科中的应用

目的探讨功能磁共振成像(fMRI)辅助神经导航技术结合术中脑电监测对脑功能区癫痫患者术中功能区定位的意义及手术效果的评估。方法对18例头皮脑电异常放电部位位于功能区的难治性癫痫患者(12例位于感觉运动区,6例位于语言区)术前进行fMRI扫描后,将导航序列的fMRI影像传输至神经导航仪,术中应用导航系统定位感觉运动区及语言区,应用术中脑电监测,对癫痫起源部位进一步精确定位,术中最大限度的切除致痫灶,对波及功能区的病灶实行皮层电灼术或多处软膜下横切(MST),术后常规应用抗癫痫药。结果全部患者在预定的癫痫灶局部均可记录到癫痫波,术后出现感觉运动区功能障碍者2例,言语障碍者1例,除1例出现永久感觉障碍外,其余患者均在术后1周内症状缓解。按照Engel分级评价为:I级7例,Ⅱ级5例,Ⅲ级4例,Ⅳ级2例;总有效者16例,有效率达88.9%。结论fMRI结合术中皮层脑电监测可实现个体化、实时、精确地定位病灶及毗邻的脑皮质功能区,达到在保护重要脑功能的前提下最大限度的切除致痫灶的目的。     

Simultaneous EEG and fMRI recordings (EEG‐fMRI) in children with epilepsy

By combining electroencephalography (EEG) with functional magnetic resonance imaging (fMRI) it is possible to describe blood oxygenation level–dependent (BOLD) signal changes related to EEG patterns. This way, EEG‐pattern–associated networks of hemodynamic changes can be detected anywhere in the brain with good spatial resolution. This review summarizes EEG‐fMRI studies that have been performed in children with epilepsy. EEG‐fMRI studies in focal epilepsy (structural and nonlesional cases, benign epilepsy with centrotemporal spikes), generalized epilepsy (especially absence epilepsy), and epileptic encephalopathies (West syndrome, Lennox‐Gastaut syndrome, continuous spike and waves during slow sleep, and Dravet syndrome) are presented. Although EEG‐fMRI was applied mainly to localize the region presumably generating focal interictal discharges in focal epilepsies, EEG‐fMRI identified underlying networks in patients with generalized epilepsies and thereby contributed to a better understanding of these epilepsies. In epileptic encephalopathies a specific fingerprint of hemodynamic changes associated with the particular syndrome was detected. The value of the EEG‐fMRI technique for diagnosis and investigation of pathogenetic mechanisms of different forms of epilepsy is discussed.     

颅内电极在外科治疗难治性癫痫中的应用——附20例临床报道

目的探讨颅内电极在外科治疗难治性癫痫中的应用。方法男12例,女8例,无创检查均不能准确定侧、定位。采用硬膜下和(或)深部电极进行长程视频脑电监测,电极放置部位、数量根据发作症状学和无创检查结果确定,其中皮层条状电极16例,皮层条状电极+深部电极2例,皮层条状电极+栅状电极2例。其中7例于埋藏后第4～12天行慢性电刺激以定位皮层功能区和(或)诱发癫痫发作。结果本组20例埋藏后监测2～21天,平均8.6天;17例获得定侧定位,1例明确为双侧起源,2例因其它原因被终止监测而无法定侧定位;17例行切除性手术,1例行胼胝体前部切开术,术后无一例感染。对随访6个月以上的17例作评估,满意15例(88.2%),显著改善2例。结论颅内电极能够用于定侧定位致痫灶及脑功能区,从而提高手术效果、降低神经功能障碍的发生。     

拉莫三嗪治疗顽固性癫痫的临床观察

对３０例顽固性癫痫病人进行拉莫三嗪开放添加剂治疗。为期三个月。以后仍服用，剂量１００－４００ｍｇ／ｄ３０例患者总的癫痫发作次数减少４６％，１３％完全控制。拉莫三嗪对控制各类癫痫发作均有效，总显效率达６７％，不良反应较少，主要是变态反应性皮疹，停药后消失，实验室检查完全正常。     

EEG and CT findings in poststroke epilepsy

The present study was undertaken to assess the diagnostic value of CT in patients with poststroke epilepsy, related to EEG in revealing the factors contributing to the development of epileptic fits. The EEG and CT results were evaluated in 50 patients with poststroke epilepsy and compared with those of 50 patients without epilepsy after stroke. Cortical and extensive lesions involving the cortex were more frequent among patients with poststroke epilepsy. Sparing of certain parts of cerebral cortex was observed within vasogenic lesion. This type of change was only found in the poststroke epilepsy group and may be responsible for development of epileptic fits. It seems that CT has a higher diagnostic value than EEG in evaluating the risk of development of poststroke epilepsy.     

癫痫诊疗中应用头皮脑电图偶极子定位的体会

目的总结癫痫诊疗中应用头皮脑电图偶极子定位在术前、术中、术后的意义。方法回顾性分析29例行偶极子源成像定位癫痫灶、17例进行手术治疗,术中与皮层脑电图、深部电极记录对比,参考手术治疗效果。结果术后随访无癫痫发作或偶有先兆发作12例,发作形式改变（术前大发作变为小发作）和发作次数减少75％以上3例,发作次数减少不到50％1例,无变化1例,手术总有效率为94％。结论头皮EEG偶极子的术前定位方法无创、准确,可避免创伤性检查用于癫痫病人的术前定位。