海马硬化与颞叶癫痫术前定位探讨(附12例报告)

目的　探讨对顽固性颞叶癫痫的术前定位方法。方法　将 Ｍ Ｒ 对海马硬化的诊断作为一重要参考指标与 Ｅ Ｅ Ｇ 检查相结合,对１２ 例顽固性颞叶癫痫进行术前定位诊断,并与术中皮层 Ｅ Ｅ Ｇ 检查结果和术后随访结果比较。结果　 Ｍ Ｒ 检查发现９ 例海马硬化,皮层 Ｅ Ｅ Ｇ 证实有同侧颞叶内侧放电,行选择性海马杏仁核切除术后病理证实海马硬化;未发现海马硬化改变３ 例行前颞叶切除术。随访０５ ～２ 年,疗效满意。结论　 Ｅ Ｅ Ｇ 是诊断颞叶癫痫的最重要手段, Ｍ Ｒ 发现海马硬化对致痫灶定位有重要意义。     

皮层语言功能的功能性磁共振定位研究

目的　研究语言皮层功能定位的新手段。方法　对 8例正常人和 2例颞叶癫痫患者通过背诵诗词引起语言皮层活动并行功能性磁共振 (fMR)脑扫描。结果　1 0例测试者均发现颞顶枕区皮层出现信号增强 ,其中 2例颞叶癫痫患者fMR定侧与阿米妥定侧实验一致。结论　fMR检查可发现语言皮层活动时的信号改变 ,可作为语言优势半球的无创定位方法。     

皮层脑电图监测在顽固性癫痫手术中的应用(附155例报告)

目的总结皮层脑电图在顽固性癫痫手术中的应用经验并评价手术疗效。方法 155例顽固性癫痫患者,术前行MRI、视频脑电图、单光子发射计算机断层成像与脑磁图检查,明确致痫灶,在皮层脑电图监测下手术。54例颞叶癫痫患者行颞叶前部与海马杏仁核显微切除术,47例颅内病灶患者行病灶与癫痫灶切除术,35例行癫痫灶切除术,19例致痫灶位于功能区的患者行皮层电凝及软脑膜下横纤维切断术。结果术后随访1~2年,按Engel分级:Ⅰ级88例,Ⅱ级46例,Ⅲ级13例,Ⅳ级8例。术后患者神经功能保持良好,未出现明显后遗症。结论在术前多种方法联合定位癫痫灶的基础上,应用皮层脑电图可以提高顽固性癫痫患者的手术疗效。     

颞叶癫痫的EEG和MR术前定位研究

目的：探讨ＥＥＧ、ＭＲ对颞叶癫痫（ＴＬＥ）术前定位。方法：用ＭＲ、ＥＥＧ对２０例ＴＬＥ病例进行术前定位，与术中ＥＥＧ和术后随访结果比较。结果：２０例病例中１７例依据ＭＲ及ＥＥＧ获得定位，主要在海马区域病变１２例，前颞叶５例，另３例ＭＲ检查正常，依据多次ＥＥＧ检查获得定位，随访疗效满意。结论：ＥＥＧ是诊断ＴＬＥ的重要手段，ＭＲ可对继发性ＴＬＥ作出正确诊断，ＭＲ对海马硬化检查可协助ＥＥＧ对ＴＬＥ定位诊断。     

颞叶癫Xian术前综合定位诊断

目的:研究术前对颞叶癫癎不同定位手段的综合应用。方法:采用ＥＥＧ、ＰＥＴ、ＭＲＩ、ＭＲＳ对２４例顽固性颞叶癫癎患者进行术前定位。结果:结合ＥＥＧ,ＭＲＩ,ＭＲＳ,ＰＥＴ对８３%,７９%,８５%病例作出定位;ＥＥＧ结合ＭＲＩ与ＭＲＳ,可对９２%病例作出定位;ＥＥＧ结合ＭＲＩ,ＭＲＳ,ＰＥＴ,可对９６%的病例作出定位。结论:结合ＥＥＧ,综合采用ＭＲＩ,ＭＲＳ,ＰＥＴ等手段可提高对颞叶癫癎术前定位的准确率。     

小儿顽固性颞叶癫痫的病理特点研究

目的 研究小儿顽固性颞叶癫痫的临床病理学表现.方法 80例小儿顽固性颞叶癫痫患者行标准前颞叶切除术,切除组织送病理学检查.术后随访1-5年,根据Engel分级评估手术效果.结果 切除组织病理学表现以单纯海马硬化(26例)、良性肿瘤(20例)、局灶性皮层发育不良(10例)和海马硬化合并颞叶其他病变(9例)四大类型为主.癫痫发作控制结果提示EngelⅠ级58例,Ⅱ级11例,Ⅲ级6例,Ⅳ级5例.结论 小儿顽固性颞叶癫痫病理表现多样,以海马硬化、良性肿瘤和局灶性皮层发育不良最常见;颞叶切除疗效肯定;病理类型与手术效果之间的关系仍待更多研究.     

功能性大脑半球切除术治疗婴幼儿性偏瘫伴顽固性癫痫2例并文献复习

目的：探讨功能性大脑半球切除术治疗婴儿性偏瘫伴顽固性癫痫的临床疗效。方法对2例婴儿性偏瘫伴顽固性癫痫的患者行功能性大脑半球切除术,即主要以切除患者中央区和颞叶为主,并行额叶及顶枕叶的白质离断,术后随访观察其临床治疗效果。结果2例患者的癫痫发作均完全控制,较术前无新的神经功能缺失。结论严格把握功能性大脑半球切除术的手术指征,对婴幼儿性偏瘫伴难治性癫痫患者的癫痫发作可起到良好的疗效。     

颞叶低级别胶质瘤继发顽固性癫痫的外科治疗

目的探讨颞叶低级别胶质瘤继发顽固性癫痫患者的临床特点、术前评估及外科治疗效果。方法对31例颞叶低级别胶质瘤继发顽固性癫痫患者术前进行MRI、视频脑电图（VEEG）、发作间期正电子发射断层扫描（PET）检查,综合分析检查结果,制定相应手术方案。术中行皮层脑电描记（ECoG）,术后对切除组织进行病理检查,并对患者进行术后随访。结果29例（93．5％）患者术后癫痫发作完全或部分缓解,2例（6．5％）患者无明显缓解。结论对于颞叶低级别胶质瘤继发顽固性癫痫的患者．术前进行综合评估,同时切除病灶及致痫灶是控制癫痫发作、改善预后的有效手段。     

颞叶癫痫病灶切除的临床应用研究(附30例临床与病理分析)

本文对30例颞叶癫痫患者进行痫灶切除的研究。其中男性15例,女性15例。手术均在皮层脑电图监测下进行,术后总有效率为93％,重点讨论了颞叶癫痫的临床表现与痫灶定位。还根据皮层脑电图探查结果及手术切除颞叶的范围将颞叶癫痫分为五型,即:颞极型;内基底缘型;颞叶新皮层及后部型;岛叶及额叶底型;外侧及颞底型,这种分类对指导痫灶的切除有现实意义。     

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.     

Study of hemispheric lateralization of language regions by functional MRI. Validation with the Wada test

Language hemispheric dominance can be assessed by the Wada test before temporal lobectomy, in patients with refractory epilepsy of the mesial temporal lobe. Functional MR is a less invasive technique which recently demonstrated the ability to localize some language areas. The aim of this study was to determine if functional MR can be substituted to the Wada test in the determination of language dominance. Seven patients with a refractory epilepsy of the mesial temporal lobe were included. The MR protocol was carried out using a 1.5 T system including 12 axial gradient echo BOLD EPI images. A semantic fluency task, interspersed with rest periods, was used as activation paradigm. An activation of middle and inferior frontal region was found in all patients. It predominated in the left hemisphere in 6 cases and in the right hemisphere in 1 case. The hemispheric and frontal lobe lateralization of the functional MR activation was correlated with the hemispheric language dominance as assessed by the Wada test. In conclusion, functional MR is a promising technique in the determination of language dominance.     

Reorganized cerebral metabolic interactions in temporal lobe epilepsy.

Patients with left temporal lobe epilepsy demonstrate language impairments that are not well understood. To explore abnormal patterns of brain functional connections with respect to language processing, we applied a principal component analysis to resting regional cerebral metabolic data obtained with positron emission tomography in patients with right- and left-sided temporal lobe epilepsy and controls. Two principal components were expressed differentially among the groups. One principal component comprised a pattern of metabolic interactions involving left inferior frontal and left superior temporal regions-corresponding to Broca's and Wernicke's areas, respectively-and right mesial temporal cortex and right thalamus. Functional couplings between these brain regions were abnormally enhanced in the left-sided epilepsy patients. The right thalamic left superior temporal coupling was also abnormally enhanced in the right-sided epilepsy patients, but differentially from that in the left-sided patients. The other principal component was characterized by a pattern of metabolic interactions involving right and left mid prefrontal and right superior temporal cortex. Although both the right- and left-sided epilepsy patients showed decreased functional couplings between left mid prefrontal and the other brain regions, a weaker right-left mid prefrontal coupling in the left-sided epilepsy patients best distinguished them from the right-sided patients. The two mutually independent, abnormal metabolic patterns each predicted verbal intelligence deficits in the patients. The findings suggest a site-dependent reorganization of two independent, language-subserving pathways in temporal lobe epilepsy.     

Unimpaired sentence comprehension after anterior temporal cortex resection

Functional imaging studies have demonstrated involvement of the anterior temporal cortex in sentence comprehension. It is unclear, however, whether the anterior temporal cortex is essential for this function. We studied two aspects of sentence comprehension, namely syntactic and prosodic comprehension in temporal lobe epilepsy patients who were candidates for resection of the anterior temporal lobe. METHODS: Temporal lobe epilepsy patients (n=32) with normal (left) language dominance were tested on syntactic and prosodic comprehension before and after removal of the anterior temporal cortex. The prosodic comprehension test was also compared with performance of healthy control subjects (n=47) before surgery. RESULTS: Overall, temporal lobe epilepsy patients did not differ from healthy controls in syntactic and prosodic comprehension before surgery. They did perform less well on an affective prosody task. Post-operative testing revealed that syntactic and prosodic comprehension did not change after removal of the anterior temporal cortex. DISCUSSION: The unchanged performance on syntactic and prosodic comprehension after removal of the anterior temporal cortex suggests that this area is not indispensable for sentence comprehension functions in temporal epilepsy patients. Potential implications for the postulated role of the anterior temporal lobe in the healthy brain are discussed.     

颞叶癫 的EEG和MR术前定位研究

目的：探讨 ＥＥＧ、ＭＲ对颞叶癫癎（ＴＬＥ）术前定位。方法：用 ＭＲ、ＥＥＧ对 ２０例 ＴＬＥ病例进行术前定位,与术中 ＥＥＧ和术后随访结果比较。结果：２０例病例中１７例依据ＭＲ及ＥＥＧ获得定位,主要在海马区域病变１２例,前颞叶５例．另３例ＭＲ检查正常,依据多次ＥＥＧ检查获得定位,随访疗效满意。结论：ＥＥＧ是诊断ＴＬＥ的重要手段,ＭＲ可对继发性ＴＬＥ作出正确诊断,ＭＲ对海马硬化检查可协助ＥＥＧ对ＴＬＥ定位诊断。     

Funktionelle Magnetresonanztomographie von Ged?chtnisfunktionen

Chronic epilepsy is frequently accompanied by cognitive deficits. Temporal lobe epilepsy (TLE) as well as resection surgery on the temporal lobe may affect cognitive function, in particular verbal and visual memory but also working memory. Epilepsy arising from the brain??s temporal lobe can be controlled surgically in up to 70% of patients. The goals of epilepsy surgery are to remove the brain areas generating the seizures without causing or aggravating memory dysfunction. This requires accurate localization of areas responsible for memory function (eloquent cortex). Functional magnetic resonance imaging (fMRI) is increasingly being used to lateralize and localize brain areas involved in memory processes and shows promise for predicting the effects of temporal lobe resection on memory function, especially when combined with other structural as well as functional imaging methods.     

Language activation distributions revealed by fMRI in post-operative epilepsy patients: differences between left- and right-sided resections

OBJECTIVE: To reveal differences of cerebral activation related to language functions in post-operative temporal lobe epilepsy (TLE) patients. METHODS: Right (RTL) and left temporal lobe (LTL) resected patients, and healthy controls were studied using functional magnetic resonance imaging (fMRI). Only patients with complete left-hemispheric language dominance according to the intracarotid amytal procedure (IAP) were included. Language-related activations were evoked by performing word generation and text reading language tasks. Activation lateralization and temporo-frontal distribution effects were analysed. RESULTS: For word generation, only LTL patients showed reduced left lateralized activation compared to controls, due to a decrease in activation in the left prefrontal cortex and an increase in the right prefrontal cortex. For reading, the left-hemispheric lateralization in RTL patients increased because of enhanced activity in the left prefrontal cortex, whereas for LTL patients the activation became bilaterally distributed over the temporal lobes. Lateralization results between pre-operative IAP and post-operative fMRI were highly discordant. Significant temporo-frontal distribution changes manifested from the reading but not from the word generation task. CONCLUSION: The cerebral language representation in post-operative LTL epilepsy patients is more bi-hemispherically lateralized than in controls and RTL patients. Post-operative temporo-frontal and interhemispheric redistribution effects, involving contralateral homologous brain areas, are suggested to contribute to the cerebral reorganisation of language function.     

立体定向海马深部电极置入在颞叶癫痫外科中的应用

目的探讨应用立体定向技术双侧海马置入深部电极脑电监测对颞叶癫痫的定侧定位价值。方法对15例无创影像及脑电检查难以定侧定位的颞叶癫痫患者,在MR定位引导下行立体定向双侧海马深部电极置入,视频脑电监测描记发作期及发作间期脑电图,根据监测结果对癫痫灶进行定侧定位,行个体化癫痫外科手术治疗,术后正规口服抗癫痫药物并随访。结果术后随访最长44个月,最短8个月,平均21个月。疗效满意8例（54%）,显著改善5例（33%）,良好2例（13%）。术后1例出现视野缺损,无其他严重并发症。结论立体定向双侧海马深部电极置入及脑电监测,微创、安全、准确,是难治性颞叶癫痫定侧定位的可靠的方法,对制定个体化手术方案具有决定性作用。     

Contralateral motor automatisms in neocortical temporal lobe epilepsy

BACKGROUND: The lateralizing value of the motor automatisms is generally doubted in most patients with temporal lobe epilepsy. However, subgroup analysis of the seizures of temporal lobe origin suggests a role for motor automatisms in discriminating seizures of neocortical versus mesial temporal lobe origin. METHODS: Video-EEG of a patient with well-defined neocortical temporal lobe epilepsy was reviewed to assess the localizing value of motor automatisms. RESULTS: We report a patient with left upper extremity motor automatisms and clonic movements of the proximal left lower extremity with altered awareness as the sole manifestations of right temporal neocortical seizures. CONCLUSION: Early onset unilateral motor automatisms without dystonic posturing can localize the seizure origin to the contralateral temporal lobe neocortex.     

Surgical treatment for intractable epilepsy: update and future]

For successful surgical treatment of intractable epilepsy, identification of the epileptogenic area and functional cortex, by using the intracranial electrodes such as subdural and depth electrodes, is important. Since 1994, via chronic subdural electrodes recording, we performed anterior temporal lobectomy with hippocampectomy for 18 patients with temporal lobe epilepsy. For 10 patients with extratemporal lobe epilepsy, cortical resection of the epileptogenic cortex was performed. For the epileptogenic cortex overlapping with functional area, we added the multiple subpial transection. Favorable postoperative seizure outcome was obtained in most of the patients. Although non-invasive presurgical evaluation modalities such as MRI, video-EEG monitoring, MEG, and FDG-PET are useful in the diagnosis of epilepsy, it is impossible to localize precisely the exact epileptogenic zone and functional cortex.