幕上胶质瘤致癫相关因素分析

目的探讨幕上胶质瘤致癫相关因素。方法回顾性分析175例幕上胶质瘤病人的临床资料,其中伴发癫51例(29.1%);并对肿瘤部位、影像学特点、侵犯皮质及病理类型等致癫相关因素进行统计分析。结果额叶胶质瘤癫发生率明显高于其他部位胶质瘤(P0.01),少枝胶质细胞瘤及低级别星形细胞瘤易于发生癫(P0.017),肿瘤侵犯皮质病人癫发生率明显高于未侵犯皮质者(P=0.01)。结论幕上胶质瘤伴发癫与肿瘤所在部位、病理类型及侵犯皮质相关。对于此类病人不仅需手术切除肿瘤,还应控制癫发作,减少并发症,提高生存质量。     

脑胶质瘤致癫痫因素临床分析

目的探讨脑胶质瘤致癫痫因素。方法回顾性分析我院2002年3月至2006年6月收治的137例脑胶质瘤患者的临床资料。结果在137例脑胶质瘤中51例(37.23%)伴发癫痫。肿瘤主体位于额叶、颞叶部位者癫痫发病率高,具有钙化、肿瘤累及皮层和没有明显占位效应的胶质瘤容易引发癫痫,低级别胶质瘤患者癫痫发病率明显高于高级别胶质瘤患者(P<0.05)。结论胶质瘤伴发癫痫与其病理类型、肿瘤生长部位及特征有关;癫痫发作类型与肿瘤所在部位密切相关。     

幕上胶质瘤伴发癫痫的临床分析

目的分析幕上胶质瘤伴发癫痫的临床特点及两者之间的相关性。方法回顾性分析我院自2000年1月至2006年12月收治的51例以癫痫为首发症状或主要症状的幕上胶质瘤患者的临床资料。结果51例患者中有50例行开颅手术，术后病理检查证实，星形细胞瘤Ⅰ级23例，Ⅱ级18例，Ⅲ-Ⅳ级9例。术后所有病例均继续服抗癫痫药物治疗，癫痫基本得到控制。结论以癫痫为首发症状或主要症状的胶质瘤以低级别的较多，外科治疗效果较好；胶质瘤引起的周围水肿和牵拉效应可能是继发癫痫的病因。     

幕上胶质瘤术后早期癫痫发作危险因素分析

目的探讨胶质瘤术后早期癫痫发作的危险因素。方法对2010年1月～2011年12月我院接受开颅手术的256例胶质瘤临床资料进行单因素及多因素Logistic回归分析。结果术后早期癫痫发作的患者16例,发生率为6.25%,其中部分性发作7例(43.75%),全身强直阵挛性发作9例(56.25%),癫痫持续状态1例(6.25%)。单因素分析显示,术前癫痫史、肿瘤位置、术后是否水肿明显及瘤腔是否有出血与胶质瘤术后早期癫痫发作相关(P<0.05),进一步多因素Logistic回归分析,结果显示仅术前癫痫史、肿瘤位置及瘤腔是否出血为危险因素,其OR值分别为4.339、3.073、2.771。结论术前癫痫史、肿瘤位置及瘤腔是否出血是幕上胶质瘤术后早期癫痫的发生的危险因素。     

幕上胶质瘤伴继发癫痫64例临床分析

目的 研究以癫痫为首发症状的胶质瘤特点,为临床癫痫治疗提供参考.方法 收集2011年1月至2012年8月北京天坛医院神经外科收治的病理确诊为胶质瘤,并以癫痫为首发症状的患者,分析癫痫发作与肿瘤部位和病理的关系.结果 收集到病理确诊的幕上胶质瘤患者171例,其中64例以癫痫为首发症状.低级别胶质瘤癫痫发生率显著高于高级别胶质瘤患者(P＜0.05),星形细胞瘤与少突星形细胞瘤癫痫发生率显著高于其他病理类型(P＜0.05).额叶与额顶叶胶质瘤癫痫发生率显著高于其他类型胶质瘤(P＜0.05).结论 胶质瘤继发癫痫与肿瘤部位和病理类型密切相关.     

幕上胶质瘤伴癫痫临床治疗效果分析

目的比较肿瘤全切除术与次全切术对幕上胶质瘤伴癫痫的治疗效果。方法我院2010-06—2014-06收治的60例幕上胶质瘤伴癫痫患者为研究对象,根据不同术式将其分为全切组(n=40)与次全切组(n=20),术后随访3~12个月,比较2组癫痫预后控制效果,另外,比较术中致痫灶处理与否癫痫控制满意率。结果全切组癫痫控制有效率87.5%,高于次全切组的75.0%,但无显著差异(P0.05)。肿瘤全切、次全切术中致痫灶处理后癫痫控制满意率分别为87.0%、81.8%,显著低于致痫灶未处理的58.8%、33.3%,差异有统计学意义(P0.05)。结论肿瘤全切除术与次全切除术治疗母幕上胶质瘤伴癫痫疗效无显著差异,但术中致痫灶处理能明显提高癫痫控制满意率。     

合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素分析

目的探讨合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素。方法回顾性分析2015年6月至2019年1月手术治疗的80例合并癫痫的幕上低级别胶质瘤的临床资料。术后1年,采用Engel分级评估癫痫预后,Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。用多因素logistic回归分析检验影响癫痫预后的影响因素;受试者工作特征(ROC)曲线分析术前癫痫发作频率预测癫痫预后的价值。结果80例中,术后癫痫预后良好59例,预后不良21例。多因素logistic回归分析结果显示,异柠檬酸脱氢酶(IDH)1突变和术前癫痫发作频率高是胶质瘤病人术后癫痫的独立危险因素(P<0.05),全切肿瘤和术后化疗是保护性因素(P<0.05)。术前癫痫发作频率预测癫痫预后的ROC曲线下面积为0.805(95%置信区间0.685~0.914;P<0.05);当术前癫痫发作频率≥2次/月时,预测术后癫痫预后不良的灵敏度和特异度分别为92.86%和46.85%。结论IDH1突变和术前癫痫发作频率高是合并癫痫的幕上低级别胶质瘤病人癫痫预后不良的危险因素,而肿瘤全切除和术后化疗明显改善癫痫预后。     

脑胶质瘤术后晚期癫痫发生的危险因素分析

目的 探讨胶质瘤术后晚期癫痫发生的危险因素.方法 回顾分析接受手术并有完整临床资料的胶质瘤病例305例,以性别、年龄、主要症状、阳性体征、术前癫痫、病变部位、手术入路、动静脉损伤、肿瘤残留、术后水肿、病理性质、早期癫痫、病变复发、手术次数、放射治疗等15项可能的影响因素为自变量,设定术后“发生晚期癫痫”为因变量,使用Logistic逐步回归分析研究相关的影响因素.结果 术前癫痫、病变部位、肿瘤残留、病变复发、术后水肿5个因素是术后晚期癫痫发生的危险因素.结论 胶质瘤患者术后晚期癫痫的发生影响患者的生活质量,针对晚期癫痫发生危险因素的防治,有利于减少胶质瘤术后晚期癫痫的发生,从而改善患者的生活质量.     

神经导航下等体积切除幕上胶质瘤

目的探讨神经导航等体积切除幕上胶质瘤的方法与疗效。方法回顾性总结37例该类病例,对术式的优点和注意事项进行分析。结果肿瘤等体积切除34例,次全切除3例。术后肢体肌力下降3例,肌力下降伴语言障碍加重2例,语言障碍加重2例。术后4周仅1例轻瘫,1例不全性运动性失语,余病人均恢复。结论在磁共振引导下,应用神经导航手术可对大脑半球不同部位的胶质瘤行影像学等体积切除。     

仅有癫痫表现的幕上胶质细胞瘤65例手术疗效

目的探讨仅有继发性癫痫表现的幕上胶质瘤的手术疗效及其影响因素.方法对经手术治疗、仅有继发性癫痫表现的65例幕上胶质瘤患者进行回顾性分析,探讨性别、年龄、术前癫痫病程、癫痫发作类型、肿瘤部位、手术切除程度等对癫痫预后的影响.结果本组男性34例,女性31例,平均年龄35.3岁,首次发作癫痫的平均年龄31.5岁,术前癫痫病史平均36.4个月.56例( 86.2% )为高分化型(low-grade)胶质瘤,9例(13.8%)为低分化型(high-grade)胶质瘤.开颅脑肿瘤切除术后神经系统并发症发生率为20.3%.术后癫痫控制有效率为66.2%.性别、年龄和术前癫痫病程与癫痫预后无关.部分性发作者癫痫预后较全身性发作者好( P <0.05).额叶和顶叶肿瘤术后神经系统并发症发生率较颞叶肿瘤高( P <0.05),而颞叶肿瘤术后癫痫控制效果较额叶和顶叶肿瘤好( P <0.05).肿瘤全切除和次全切除者的癫痫控制效果比部分切除和单纯活检病例的癫痫控制效果显著好( P <0.001).该组患者经综合治疗后预后较好,长期生存率高.结论仅有继发性癫痫表现的幕上胶质瘤多为高分化型,是胶质瘤中预后相对较好的特殊类型,癫痫发作类型、肿瘤部位和手术切除程度具有预后价值.     

Timing of Seizure Recurrence in Adult Epileptic Patients: A Statistical Analysis

Seizure diaries were maintained prospectively in 24 epileptic patients (19 with partial complex, three with partial simple, and three with primary generalized seizures) who were selected consecutively, had stable seizure patterns, were reliable historians, and were known to be compliant with medications. Diaries were maintained for an average of 237 days (range, 61-365), and an average of 18 seizures were recorded per patient (range, 5-76). Seizure patterns were analyzed by using the methods appropriate for a time series of events (point process). Two patients had a decreasing trend in seizure frequency. For 12 patients, seizure occurrence was indistinguishable from that of a Poisson process. The remaining 10 patients had an exponential distribution of seizure intervals, but did not fit other criteria for a Poisson process; 3 of these showed evidence for seizure clustering; none showed evidence for a seizure cycle. It is concluded that the pattern of seizure occurrence in most epileptic people is random, but in approximately 50%, it is not occurring according to a Poisson process. These observations indicate that seizure cycling and/or clustering are not common in epileptic patients, but do not exclude the possibility that seizures have been precipitated by some randomly occurring event, such as sleep deprivation or increased stress.     

Spread of Epileptic Seizure Activity in Humans

A computer-augmented approach to ictal EEG analysis has been developed. A method for determining both the predictability of one signal from another and the time delay between those two signals--the average amount of mutual information (AAMI) method--has been applied to representative seizures of two patients with focal-onset seizures and one patient with generalized seizures. High AAMI values characterized the EEG derived from the sites of the epileptic foci. AAMI values were high in all sampled brain areas in the patient with generalized seizures. Time delays were not consistent in any subject. The results indicate that the AAMI technique can differentiate focal from generalized seizures and identify the site of seizure onset.     

全脑照射治疗大鼠癫痫的实验研究

目的 观察20Gy外照射对大鼠癫痫模型癫痫发作的影响，并着重检测该剂量照射后大鼠脑皮层内兴奋性氨基酸类递质—谷氨酸含量的变化。方法 建立戊四氮慢性癫痫模型，继以用20Gy剂量对模型大鼠皮层进行垂直照射。照射后48h，观察大鼠对致癫刺激的反应，并在接受致癫刺激后30min，取大鼠皮层，利用高压液相检测其中谷氨酸含量。结果 癫痫模型大鼠接受20Gy照射后48h，其癫痫发作明显受抑制。谷氨酸的检测结果显示，未接受照射的模型大鼠，受到致癫刺激后，脑内谷氨酸含量明显升高；而照射后的模型大鼠，接受相同刺激，脑内谷氨酸含量却没有明显升高。结论20Gy外照射后48h即可抑制模型大鼠癫痫发作，其抑制作用可能与照射降低了脑内兴奋性氨基酸类递质—谷氨酸的作用有关。     

Factors Affecting the Outcome of MMPI and Neuropsychological Assessments of Psychogenic and Epileptic Seizure Patients

The literature reveals conflicting information regarding the extent to which psychogenic seizure patients have emotional disorders and neuropsychological deficits as compared with patients with epileptic seizures. Among groups matched for numbers of subjects, age, sex, and years of education, we observed that patients who had solely psychogenic seizures with either a major component of affectual expression or relatively minor motor activity were more disturbed emotionally than epileptic patients with partial seizures. In contrast, the personality characteristics of psychogenic seizure patients whose attacks had either little affectual display or prominent motor expression could not be distinguished from those of epileptic patients with convulsive generalized seizures. Closely matched groups of patients with solely psychogenic seizures, partial seizures, or generalized seizures did not differ in neuropsychological performance. However, psychogenic seizure patients performed much better on neuropsychological measures than a less-well-educated, but otherwise matched group of patients with generalized epileptic seizures.     

Computerized Analysis of EEG Background Activity in Epileptic Patients

Background activity was studied in 128 idiopathic epilepsy patients and 30 normal controls using EEG topography and t-statistic significance probability mapping (t-SPM). In epileptic patients, EEG background activity showed a marked increase in delta, theta, alpha 1, and beta 1, and a decrease in alpha 2 activity as compared with controls. Untreated epileptic patients had a significant increase in delta, theta, and alpha 1 as compared with controls. For epileptic patients treated with antiepileptic drugs (AEDs), the most marked slowing was observed in the polytherapy group, followed by the monotherapy group and then the untreated group. Among seizure types, patients with partial seizures (PS) tended to exhibit more slowing than patients with only generalized tonic-clonic seizures (GTC). Moreover, PS had a right-left asymmetry in alpha 2 and beta 1 activities. In a comparison of AEDs, patients receiving carbamazepine (CBZ) and phenobarbital (PB) showed no significant difference as compared with the untreated group. In contrast, patients receiving valproate (VPA) showed a decrease in slow and fast activities. EEG changes associated with each AED were different in GTC and PS. Patients receiving VPA for GTC showed a decrease in theta and beta 1 activities, but those with PS showed a decrease only in delta activity.     

Epileptic Seizures in Elderly Patients with Dementia

All inpatients aged greater than 55 years with dementia in the Dundee Psychiatric Service were surveyed for seizure occurrence by interviewing staff and reviewing records. Of 208 patients, 19 (9.1%) were recorded as having seizures. The seizures were major in 92% and occurred at a rate of approximately 2.3 seizures per patient per year. Patients with epilepsy were significantly younger than a control group of dementia inpatients and were significantly more cognitively impaired on the survey Clifton Assessment Procedure for the Elderly (CAPE), but not on the Mini Mental State Examination. Of 111 reported accidents, only 5 appeared to be associated with epilepsy. Although epileptic seizures are relatively common in patients with severe dementia, they rarely caused severe problems.