PET辅助定位脑软化灶伴发难治性癫痫的伽玛刀治疗

目的 探讨正电子发射断层扫描（PET）对脑软化灶伴有难治性癫痫的定位价值和1-刀治疗的效果。方法 对18例脑软化灶伴有难治性癫痫的患者进行PET检查，根据PET检查结果并结合MRI、CT、视频脑电图、VEEG及临床表现确定放射治疗靶区。结果 14例致痫灶位于脑软化病灶周围的皮层组织．4例致痫灶不仅位于脑软化病灶周围，还位于其他脑叶或远隔部位。18例经γ-刀治疗后随访12-48个月，平均16个月，满意8例，显著改善5例，良好3例，无效2例，有效率88．9％（16／18）。均未见新的并发症发生。结论对脑软化灶伴有难治性癫痫发作患者行PET检查定位致痫灶，有助于选择γ-刀治疗方案，提高γ-刀治疗效果。     

脑卒中后继发癫痫的临床分析

目的 探讨脑卒中继发癫痫的临床特征、发病机制及预后。方法 回顾性分析7年来脑卒中860例继发癫痫发作68例的临床资料。结果 卒中后癫痫的发生率为7．91％，早期发作5．08％，晚期发作3．02％，前多见于蛛网膜下腔出血、脑出血、心源性脑梗死；后多见于动脉血栓性脑梗死。结论 脑卒中后癫痫的发生与病灶部位(皮质，／皮质下)有关．病损累及皮层是重要的的致痫因素，多脑叶受累使癫痫发生的危险性增加，血肿刺激和出血后脑水肿、颅内压增高、缺血及缺氧，使大脑皮层神经元大量放电是早期癫痫发作的重要机制，晚期癫痫发作是与胶质细胞增生、疤痕形成、萎缩粘连或中风囊等致痫灶有关。     

50例脑囊虫病伴发癫痫临床分析

目的 探讨脑囊虫病伴发癫痫的临床特征及发生机制。方法 对70例脑囊虫病患者中50例并发癫痫者的发作形式，影像学表现等进行回顾性分析。结果 本组71.4%(50/70)的脑囊虫病患者并发癫痫，发作形式分别为；全身强直-阵挛性发作25例（50.0%)。单纯部分性发作10例（20.0%)，复杂部分性发作7例（14.0%)，失神发作2例（4.0%)，癫痫持续状态1例（2.0%)。两种或两种以上形式发作5例（10.0%)；影像学主要表现为脑实质内单个或多个散在低密度或高密度以及钙化等圆形或卵圆形病灶或异常信号，结论 癫痫发作是脑囊虫病患者最主要的临床表现。发作形式的多样性及易转换性可能是本病的特征之一。癫痫发作与虫体的生活状态以及囊虫蜕变死亡时释放大量抗原和毒素引起机体变态反应性脑水肿有关。     

发作间期颞叶癫痫的18F-FDG PET 显像研究

目的：采用诊断试验评价方法评估发作间期^18F-FDG PET显像对颞叶癫痫定性和病业定位的诊断价值，探讨其外科治疗的意义。方法：26例CT或MRI检查正常，经临床及脑电图诊断的颞叶癫痫患者在同期进行发作间期^18F-FDG PET脑显像，图像通过目测和半定量的方法进行分析，PET显示的低代谢区行皮层脑电图（EcoG）或深部脑电图（DEEG）描记以评估^18F-FDG PET检测癫痫灶的特异性，17例定位明确的单侧颞叶癫痫行前颞叶切除术，术手进行随访。2例PET未检出癫痫灶，7例DEEG定位双侧病灶未行手术治疗。结果：26例颞叶癫痫中，发现^18F-FDG PET对癫痫灶检出的灵敏度为92%（24/26），特异度为87%(21/24)。结论：从颞叶癫痫的定性定位诊断来看，发作间期^18F-FDG PET脑显像对癫痫灶的检出率较高，但^18F-FDG PET显示的低代谢区与癫痫灶的位置并非完全重叠，尚需要其他的诊断措施加以肯定，^18F-FDG PET和皮层脑电图或深部脑电图对癫痫病灶定位的一致性是手术成功的关键。     

脑囊尾蚴病癫痫型治疗的转归与临床分析

目的 分析脑囊尾蚴病（即脑囊虫病）癫痫型治疗的转归。探讨不良转归的干预对策。方法 根据临床和3年随访资料对124例脑囊虫病癫痫型的治疗效果进行观察。结果 痊愈56例，坚持服用抗癫痫药控制发作36例，仍然发作癫痫27例，驱虫治疗后并发颅内高压2例。其中并发脑疝死亡1例。驱虫药致肝功能受损19例，复查头频CT病灶消失61例。病灶数减少或范围缩小17例。无明显变化37例。发现脑内新增钙化点6例。新生肉芽肿2例。并发脑积水1例。结论 单纯的驱虫治疗不一定能彻底控制癫痫等并发症的发生，综合治疗方案应包括驱虫，降颅压，正规抗癫痫和防治重复感染。     

脑卒中继发癫痫59例临床分析

目的 分析脑卒中患者继发性癫痫的临床特点.方法 选取1999年4月～2002年6月我院门诊及住院的脑卒中继发癫痫患者59例,就其发病、诊断、病因及治疗做以回顾性分析.结果 本组统计脑卒中后癫痫总发病率为11.01%.发作类型以全面性发作为主,占45.76%,发作时间以卒中发生2周内为主,占71.19%.大脑皮层区病灶和脑叶病灶癫痫的发生率较其他部位病变的发生率明显高,急性期住院期间死亡率为27.12%.结论 脑卒中是老年人继发性癫痫的最常见原因,癫痫发作对患者预后的影响很大,应积极控制癫痫发作,治疗原发病及伴发疾病.     

伴有癫痫发作的脑内病灶的手术治疗

目的 研究伴有癫痫发作的脑内病灶的手术治疗效果。方法 本组24例病人中，EEG示13例有局部痫样波，5例局灶慢波，6例正常。在皮质脑电图(ECoG)监测下手术．11例痫灶位于病灶表面或紧邻其边缘，行病灶 痫灶切除；8例痫灶距病灶10mm以上，其中6例位于非功能区，行病灶 痫灶切除；2例位于功能区，行病灶切除及热凝痫灶皮质；2例痫灶位于前颞叶深部，行前颞叶及病灶切除。3例ECoG正常，仅行病灶切除。结果 21例痫灶切除病人中，15例(71％)术后癫痫完全消失，2例(10％)发作显减少，4例(19％)发作减少。结论 对伴有癫痫发作的脑内病灶病人，术中ECoG及深部电极有助于精确定位痫灶；切除病灶、痫灶，效果良好。     

青霉素致癫痫动物模型的机制研究：Ⅰ.细胞学和生化学机制

青霉素是建立癫痫动物模型最常用的药物之一,许多学者将青霉素腹腔注射或在脑皮质表面应用,成功地诱导出类似于人类皮质癫痫的动物模型,为癫痫的发病机制和药物、手术治疗方法的研究提供了重要的手段。本文综述了癫痫样发作的发生、发展机制和青霉素在此过程中所起的作用。一、     

卒中后早期癫痫的临床分析

目的对卒中后早期癫痫的临床研究。方法通过回顾性病例和随访观察。结果卒中后早期癫痫的发生率为11．94％，癫痫发作常发生在卒中后24h内，占75．5％。癫痫发作与卒中CT所见部位密切相关，皮质病灶较皮质下病灶更易发生癫痫。结论卒中后早期癫痫发作是迟发性癫痫的危险因素。     

外伤性癫痫的临床特征分析及手术治疗

目的 总结外伤性癫痫的临床特征及手术效果。方法 对病人进行神经学检查及EEG、CT、MRI及ECT检查，确定致痫灶后手术治疗，手术中行皮层及深部脑电监测。结果 外伤性癫痫病人32例，年龄10至45岁。临床主要表现有全身强直痉挛性发作、部分性发作、精神运动发作、失神发作。头皮脑电图显示32例病人中30例患者有与损伤部位或对冲部位相符的恒定局限性高波幅尖波、棘波和棘慢波。所有病人均在皮层及深部脑电监测下切除病灶。术后15例已完全停止发作，16例已明显好转，1例无明显改变。结论 外伤性癫痫的临床特点包括局灶性发作多见，癫痫发作形式多样和致痫灶在影像学改变附近。手术切除病灶能获良好效果。     

Psychiatric Patients Showing Irregular β Activities in EEGs and Treatment with Antiepileptic Drugs: A Report of 15 Cases†

Abstract: Fifteen psychiatric cases are reported who were clinically diagnosed as schizophrenic, affective disorders, or neurotic, but resisted standard medication regimens, all showing irregular β activities on EEGs. The cases tended to display symptoms in common, such as dysphoria, emotional instability or frequent physical complaints. These characteristic symptoms share something mutually with the symptoms shown in some epileptic patients or psychiatric patients with epileptic EEG abnormalities without clinical seizures. Antiepileptic drugs seemed more specifically effective to the above symptoms. More than half of these cases showed improvement on EEG findings such as a decrease in irregular β activities and an increase in rhythmicity or regularity of α activities along with clinical improvement with the administration of adjunctive antiepileptic drugs. These results suggest that the adjunctive administration of antiepileptic drugs to patients with irregular β activities on EEGs is clinically useful and an EEG examination has much value in psychiatric practice to find the criteria of drug therapy.     

Psychiatric patients showing irregular beta activities in EEGs and treatment with antiepileptic drugs: a report of 15 cases

Fifteen psychiatric cases are reported who were clinically diagnosed as schizophrenic, affective disorders, or neurotic, but resisted standard medication regimens, all showing irregular beta activities on EEGs. The cases tended to display symptoms in common, such as dysphoria, emotional instability or frequent physical complaints. These characteristic symptoms share something mutually with the symptoms shown in some epileptic patients or psychiatric patients with epileptic EEG abnormalities without clinical seizures. Antiepileptic drugs seemed more specifically effective to the above symptoms. More than half of these cases showed improvement on EEG findings such as a decrease in irregular beta activities and an increase in rhythmicity or regularity of alpha activities along with clinical improvement with the administration of adjunctive antiepileptic drugs. These results suggest that the adjunctive administration of antiepileptic drugs to patients with irregular beta activities on EEGs is clinically useful and an EEG examination has much value in psychiatric practice to find the criteria of drug therapy.     

Clinical features of cases whose cerebral blood flow was preserved only in the basal ganglia region

In the series of our studies of positron emission tomography (PET), we had some cases whose cerebral blood flow was reduced in the cerebrum, cerebellum and brain stem, and was preserved only in the basal ganglia region. We studied their clinical features and electrophysiological findings of these cases. These 5 cases included neuronal ceroid lipofuscinosis, Krabbe disease, Tay-Sachs disease, progressive myoclonus epilepsy and subacute sclerosing panencephalitis. Clinically they showed symptoms associated with diffuse cerebral and brain stem involvements. Electrophysiological studies also revealed the involvements of cerebrum and brain stem. These 5 cases were classified to persistent vegetative state clinically. Vegetative state was considered to be heterogeneous concerning about cerebral metabolism. There may be one group presenting a peculiar cerebral metabolic condition described here in vegetative states. And this condition may be specific to some neurodegenerative or metabolic disorders that involve cerebellum and brain stem as well as cerebrum.     

Multiple band frequency analysis in a child of medial temporal lobe ganglioglioma

We report a 1-year 6-month-old girl with ganglioglioma in the right medial temporal lobe who showed epileptic spasms in clusters. Spasms occasionally followed a dazed and fearful gaze. Interictal electroencephalography (EEG) showed diffuse bursts of slightly irregular high-voltage spikes and slow waves without hypsarrhythmia. The findings on ictal EEG, single-photon emission computed tomography, and F-18 fluorodeoxyglucose positron emission tomography indicated focus on the right medial temporal lobe. Ictal fast rhythmic activity analysis of scalp EEG by multiple band frequency analysis showed gamma rhythms at 65–80 Hz with a high spectral power around the tumor area. Epileptic spasms completely disappeared after tumor resection. These findings suggest that the cerebral cortex may be a source of epileptic spasms and indicate the possibility of usefulness of fast activity analysis in this condition.     

脑型血吸虫病临床特征与手术治疗

目的 探讨脑型血吸虫病临床特征与手术疗效。方法 回顾分析12例脑型吸虫病临床表现。实验室检查。影像学特征。手术方式，手术结果及预后。结果 12例均行CT扫描。6例加MRI扫描，表现为片状水肿无强化3例。片状水肿区内单个或多发散在结节状等或高密度强化灶9例。血吸虫酶联免疫吸附试验阳性8例。手术治疗10例，9例行病灶切除。1例行单侧颞肌下减压术，非手术治疗2例。9例术后病检为血吸虫肉芽肿，CT复查，病灶消失，结论 脑实质内片状或散片状水肿区伴单个或多发强化密度均匀结节灶。血吸虫酶联免疫吸附试验阳性可作为诊断地依据。单发或多发结节灶伴严重脑水肿，占位效应明显为手术指标。     

Destruction of apical dendritic layers in penicillin-induced cortical epileptic focus

It has been generally accepted that topectomy is a choice of treatment for patients who have an intractable cortical epileptic focus. However, the surgery is not indicated in the cases whose focus is functionally involved in the vital cortical regions. We have experienced a case of intractable traumatic cortical epilepsy, in which the patient underwent cortical surface coagulation on his motor cortex during the dissection of his wide-spread durocortical adhesion. Subsequently, his epileptic attacks have been abolished completely for over 7 years without motor deficit. It is the purpose of this work to confirm experimentally that destruction of apical dendrites on the epileptic focus may prevent occurrence of abnormal spike epileptic discharges without vital neuronal deficit. Fifty dogs were used in this study. In normal dogs, the antidromic cortical response, after stimulation of the internal capsule, showed three predominant negative waves axonal (the first), cortical neuronal (the second) and apical dendritic potentials (the third) by surface recordings. Upon creation of the penicillin-induced cortical epileptic focus, spike discharges appeared on the corticogram, and the third wave of the antidromic cortical response shifted from negative to positive. Selected destruction of the dendrites, in the first and the second cortical layers, in the area of the epileptic focus brought about disappearance of the third wave, to isopotentially, and a marked inhibition or complete disappearance of spikes on the corticograms. The possibility exists, as been suggested by our experiment, to clinically apply this method as a treatment for intractable cortical epilepsy with foci in the functionally vital regions, although there are yet many problems to be solved.     

Epilepsy surgery in pediatric epileptic encephalopathy: when interictal EEG counts the most

Purpose

Traditionally, seizure onset localization in ictal electro-encephalography (EEG) is the main factor guiding resective epilepsy surgery. The situation is often different in infantile epileptic encephalopathy. We demonstrate the importance of the underrated interictal (rather than ictal) surface EEG in informing decision-making in epilepsy surgery for children with epileptic encephalopathy caused by subtle focal cortical dysplasia (FCD).

Methods

We present a small case series of three children who had an epileptic encephalopathy with either epileptic spasms or tonic seizures. All three were thought initially to have normal neuroimaging.

Results

Ictal EEG localizing features were seen in none and lateralizing features were seen only clinically in one of the three. However, the interictal EEG showed persistent and consistent focal irregular slowing in all, particularly after medically resolving the diffuse encephalopathy. Subtle FCDs were uncovered in all. Surgery was performed in all with excellent outcome.

Conclusion

In infantile epileptic encephalopathy caused by subtle FCD, the often underrated interictal surface EEG (particularly persistent foal irregular slowing) informs the most; not only to the target area for surgical resection but also to its extent. This may negate the need for unnecessary and sometimes non-informative invasive monitoring in these cases. A matter of “zooming out” to define the extent of a resectable abnormality rather than “zooming in” to define a seemingly localized epileptic focus that may change with time.

     

Gray matter lesions in Nasu‐Hakola disease: A report on three autopsy cases

Nasu‐Hakola disease is an autosomal recessively inherited disease characterized by lipomembranous polycystic osteodysplasia and sclerosing leukoencephalopathy. While white matter lesions prominent in the brain have been reported in the literature, gray matter lesions have not received particular attention. In this study, we examined three autopsy cases of Nasu‐Hakola disease in order to focus specifically on gray matter lesions. The ages at onset of the three cases were 20, 23 and 29 years, and the disease durations were 29, 19 and 8 years, respectively. In addition to characteristic degeneration in the cerebral white matter, such as demyelination with conspicuous fibrillary gliosis and axonal changes, all three cases showed overt pathology in the gray matter. Neuronal loss with gliosis in the thalamus (particularly in the dorsomedial nucleus and anterior nucleus), caudate nucleus, putamen and substantia nigra was prominent in all cases, and the severity corresponded to the disease duration. The cerebral cortices were relatively preserved in all cases. One case showed neuronal loss and gliosis in the gray matter of the hippocampus, possibly due to repeated episodes of epileptic convulsions. These gray matter pathologies are considered to be responsible for some of the clinical manifestations of the disease, including extrapyramidal symptoms.     

Neuronal activities in human epileptic foci and surrounding areas.

1. Extracellular microelectrode recording was carried out in human epileptogenic cortex and in the area surrounding the focus in three cases and in the hippocampus of two cases. 2. It was impossible to identify primary "epileptic" or "pacemaker" neurons. Emphasis is placed on the interactions among the neuronal aggregates at the focus for generating the epileptic discharges in the interictal stage. The possibility of plasticity in each neuronal element in the epileptogenicity is considered. Surround inhibition was not observed. The slow wave burst was accompanied by a long repetitive rhythymic burst of unitary discharge. It was shown that the slow wave burst was a modified feature of epileptic activity. 3. Various types of activity of hippocampal neurons are described, which are, however, considered as normal discharges of those neurons.     

TCA-fMRI技术在难治性癫痫致痫灶术前定位中的应用

目的探讨静息态功能性磁共振时间簇分析（TCA-fMRI）应用于难治性癫痫致痫灶术前定位的方法和价值。方法对11例难治性癫痫病人,在癫痫发作间期行静息态功能磁共振（fMRI）检查,应用TCA-fMRI技术计算与癫痫发作相关的脑内激活区（致区）,并分析比较该激活区与术中皮质电极定位致痫灶之间的吻合程度。结果 TCA-fMRI确定的激活区与术中皮质电极定位的致痫灶一致6例;激活区范围扩大3例,但最强激活区仍与皮质电极定位的癫痫灶一致;激活区较弥散2例。术后病理显示：胶质瘤3例,脑软化灶4例,灰质异位症2例,海绵状血管瘤1例,海马萎缩1例。随访1年,术后3个月、6个月及1年均复查脑电图,癫痫发作消失8例,明显减少3例;无严重并发症。结论静息态TCA-fMRI技术是一种新型、无创性的致痫灶定位方法,将静息状态下致痫灶异常放电所导致的血氧依赖水平变化在MRI三维结构图像上显示,能在术前精确定位致痫灶。