以癫为首发症状的幕上星形细胞瘤的诊疗体会

目的 探讨癫癎与星形细胞瘤的关系及影响术后癫癎控制的因素.方法 回顾性分析35例以癫癎为首发症状的星形细胞瘤患者,运用SPSS 15.0对术中肿瘤切除程度和术前癫癎病程分别与术后6个月癫癎控制情况进行卡方检验.结果 35例病人全切25例,次全切6例,部分切除4例;病理诊断(WHO)Ⅰ～Ⅱ26例,Ⅲ～Ⅳ9例;术前癫癎病程1～6个月13例,＞6个月～2年17例,2年以上5例.分别与术后6个月癫癎控制情况行卡方检验,P值分别为0.016、0.039,差异均有统计学意义.结论 以癫癎为首发症状的脑星形细胞瘤多为低级别肿瘤,手术全切及术前癫癎病程短者术后癫癎较易控制.     

幕上低级别星形细胞瘤生存分析

目的：分析影响幕上低极别星形细胞瘤（ＬＧＡ）患者生存的因素。材料和方法：对７５例经ＣＴ诊断的幕上低级别星形细胞瘤进行了单及多因素生存分析。结果：多因素分析显示年龄大于４０岁，术前无癫痫，肿瘤大于５ｃｍ，肿瘤位于丘脑或脑室，手术部分切除或活检以及病理Ｋｅｒｎｏｈａｎ分级Ⅱ级为六个影响生存的最危险因素。单因素分析结果显示年龄小于４０岁，术前有癫痫，肿瘤小于５ｃｍ，病理分级Ⅰ级以及手术全切与生存延长有明显关系。放射治疗在单因素及多因素分析中均显示对生存无明显影响。结论：手术方法、肿瘤病理分级、部位、大小及患者年龄等是决定该类肿瘤患者生存的重要因素。     

以癫癎为首发症状的小儿脑脓肿20例分析

目的 探讨小儿脑脓肿的临床症状、发病形式及治疗方法。方法 总结20例以癫癎为首发症状的该病患儿临床特 征及治疗措施。结果 全部病例经合理治疗症状缓解且病灶消失。结论 在临床上遇到不同类型癫癎发作的患儿,应考虑有脑脓 肿的可能,尽快行头颅CT检查明确病因,合理治疗。     

以癫(癎)为首发症状的急性脑血管病50例临床分析

目的 研究急性脑血管病癫(癎)发作的相关因素及以癫(癎)为首发症状的急性脑血管病患者的近期预后.方法 对50例以癫(癎)为首发症状的急性脑血管病的临床资料进行回顾分析.结果 癫(癎)的发生与病变部位有关,以癫(癎)为首发症状者的脑卒中预后不良.结论 卒中累及大脑皮质易继发癫(癎),应积极抗癫(癎)治疗,改善预后.     

以癫癎为首发症状的颅内结核瘤5例报告

以癫癎为首发症状的颅内结核瘤，并非少见，现将我科诊治的5例报告如下。 1对象和方法 1．1一般资料于2002—03-2006—12，我科诊治以癫癎为首发症状的颅内结核瘤5例，男3例，女2例，年龄15-40岁，平均21．5岁。     

以癫癎发作为首发症状的老年患者28例病因分析

随着各项检查手段的日益完善,以癫癎发作为首发症状的各种疾病得以早期诊断,自1999-06～2003-06我院收治的28例以癫癎发作为首发症状的老年患者,报道如下.     

以癫癎样发作为首发症状的糖尿病18例分析

抽搐是癫癎的首发症状,以癫癎样发作为首发症状的糖尿病少见.现将我院1999-04～2004-05收治的18例以癫癎样发作为首发症状的糖尿病人的脑电图(EEG)及可能的发病机制与治疗原则进行分析探讨,以便尽早找出它的原发病,有利于早期诊断、治疗,以免误诊.     

110例癫癎患者停药与预后的相关分析

目的:通过对临床已获控制并停药的癫癎患者进行分析,总结并探讨癫癎预后的有关因素。方法:回顾性分析110例临床已获控制并停药患者的临床资料。结果:患者的性别与发病年龄、治疗时间均无显著性差异(P>0.05);患者的发病年龄、病程、发作类型、发作频率、影像学检查正常与否与治疗时间有显著性差异(P<0.05);而有无既往史或家族史与治疗时间无显著性差异(P> 0.05)。结论:患者发病年龄、病程、发作类型、发作频率、影像学检查正常与否影响总的治疗时间,且发作类型与停药后的复发可能密切相关。达控时间是影响癫癎预后最为重要的因素。     

低级别星形细胞瘤复发后的CT和病理变化

CT增强扫描对幕上星形胶质细胞瘤的诊断准确率高达90％以上。一般低级别星形细胞瘤为非强化的低密度,而恶性者则多明显强化。低级别星形细胞瘤约有60％～84％转化为恶性,其CT改变可能与病理相关。本文比较了1987年至1998年35例复发后再手术的该肿瘤不同时期的CT和病理改变。     

脑卒中后癫癎的临床分析

目的探讨脑卒中继发癫癎的临床特点.方法回顾分析682例脑卒中患者继发癫癎72例临床资料.结果脑卒中后继发癫癎的发生率是10.5%,与脑卒中的病灶部位有明显相关,皮质病灶显著高于皮质下病灶(P＜0.01),卒中早期型癫癎较迟发型癫癎的发生率明显增高(P＜0.05).结论早发型癫癎经积极治疗原发病症状较易控制,迟发型癫癎需正规长期服用抗癫癎药.     

Surgical treatment of patients with low-grade astrocytomas and medically intractable seizures

OBJECTIVE: Low-grade astrocytomas can present with seizures that respond poorly to antiseizure medications, with a consequent reduction in the quality of life, because of both seizures and the medication's side-effects. We report our experience with operative treatment of such patients. SUBJECTS AND METHODS: Five patients (two children and three adults) with supratentorial low-grade astrocytomas associated with severe seizures were operated on. We followed the effects of the operation on post-operative neurological deficit, seizure frequency and the quality of life. RESULTS: No serious neurological complications followed the operations. The patients were followed for a median period of 12 months (6-46). Post-operatively, three of the patients became seizure-free, one experiences only auras, and one had a great reduction in seizure frequency and severity. All patients reported great improvement in their quality of life. CONCLUSION: Resections of low-grade astrocytomas in patients with medically intractable seizures are safe procedures that effectively control seizures in the majority of patients, resulting in significant improvement in the patients' quality of life.     

Predictors of seizure outcomes in patients with diffuse low-grade glioma-related epilepsy after complete glioma removal

Aims

We aimed to identify predictors of postoperative seizures in patients with diffuse low-grade glioma (DLGG)-related epilepsy after complete tumor resection in this study.

Methods

We retrospectively collected data from individuals with DLGG-related epilepsy whose tumors were completely resected at Xiangya Hospital, Central South University between January 2014 and January 2020. The predictors of seizure outcomes were assessed by employing univariate analysis and a multivariate logistic regression model in a backward binary logistic regression model.

Results

Among the 118 cases that met the inclusion criteria, 83.05% were seizure-free following an average follow-up of 4.27 ± 1.65 years, all of whom were classified as International League Against Epilepsy class I outcome. Univariate and multivariate analyses indicated that seizure duration of >6 years (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.76–24.98; p = 0.005) and first clinical symptoms other than seizures (OR, 4.51; 95% CI, 1.43–14.23; p = 1.010) were both independent predictors of unfavorable seizure outcomes.

Conclusion

Our results imply that satisfactory seizure outcomes can be achieved in most patients with DLGG-related epilepsy after complete tumor resection. Patients with seizure duration of >6 years or first clinical symptoms other than seizures were more likely to experience postoperative seizure recurrence.     

难治性颞叶癫痫术后急性发作对远期预后的预测价值

目的探讨药物难治性颞叶癫痫术后急性发作对远期预后的影响。方法回顾性分析我院自2009年6月-2010年6月收治的52例药物难治性颞叶癫痫患者的临床资料,所有患者均接受外科治疗,术后定期门诊或电话随访。根据术后7天患者有无急性发作,分为2组,分为实验组(复发),对照组(未复发)。将2组患者随访资料、远期预后(5年)等进行对比分析。结果实验组癫痫控制满意率为35.0%,对照组控制满意率为68.8%,实验组明显低于对照组,差异有统计学意义(χ2=5.683,P=0.017)。在多元Logistic回归分析结果中,复发次数、术前使用抗癫痫药物数量、术后脑电图,术后急性发作与术前习惯性发作相似是影响远期预后的独立影响因子。结论难治性颞叶癫痫术后急性发作对患者远期预后存在影响,已明确的影响因子包括:复发次数、术前抗癫痫药≥3种,术后脑电图及术后急性发作与术前习惯性发作相似。     

颞叶癫痫患者手术后早期发作对远期疗效的影响

目的：探讨颞叶癫痫患者手术后早期发作的影响因素及其对预后的影响。方法回顾性分析2011年2月至2012年10月首都医科大学附属北京天坛医院神经外科手术治疗的96例颞叶癫痫患者的临床资料,并进行随访,分析癫痫手术后早期发作的影响因素及其对长期预后的影响。结果术后随访所有患者EngelⅠ级73例,EngelⅡ级11例,EngelⅢ级9例,EngelⅣ级3例。15例患者术后出现APOS,随访EngelⅠ级8例,EngelⅡ级3例,EngelⅢ级3例,EngelⅣ级1例。患者的年龄、性别、病程、术前发作频率、发作类型、MRI表现、切除侧别、术后病理等对术后早期发作无影响。出现术后早期发作的患者的癫痫缓解率明显低于无术后早期发作的患者（P＜0．05）,惯常发作的患者的癫痫缓解率明显低于非惯常发作的患者（P＜0．05）。结论颞叶癫痫患者术后早期发作的出现提示预后不良,发作形式表现为惯常发作的患者更容易出现癫痫复发。     

First-line nitrosourea-based chemotherapy in symptomatic non-resectable supratentorial pure low-grade astrocytomas

At the present time, there are no proven beneficial effects of chemotherapy (CT) for the treatment of pure low-grade astrocytomas. Brain radiotherapy (RT) still remains the standard treatment in order to reduce or delay tumor progression or symptoms, despite possible long-term neurologic complications. We report 10 patients, with histologically proven pure low-grade fibrillary astrocytomas, to which we administered a first-line nitrosourea-based CT. All patients were symptomatic with pharmaco-resistant epilepsy or neurologic symptoms, and had been rejected for neurosurgical resection. All patients with epilepsy had a clinical improvement with reduction in seizure frequency and 60% became seizure-free. CT was well tolerated; all patients developed myelosuppression with 40% of grade III/IV hematotoxicity. Seven were alive at the time of writing with a mean follow-up of 6.5 years (3.5-12) from first recorded symptoms. The three deceased patients died 7.5, 7.5, and 8.5 years from first symptoms. These results demonstrate that some patients with symptomatic non-resectable fibrillary low-grade astrocytomas can be treated with up-front CT to improve their neurologic status. This report suggests that benefits of CT on symptoms, survival, and quality of life should be prospectively compared with RT.     

The association between seizure clustering and convulsive status epilepticus in patients with intractable complex partial seizures

PURPOSE: We examined the association between seizure clustering and convulsive status epilepticus (SE) in patients with intractable complex partial seizures, to identify whether patients whose seizures typically cluster are at high risk for convulsive SE (CSE). METHODS: Seventy-six patients with intractable complex partial epilepsy who underwent presurgical evaluation in the Montefiore Epilepsy Management Unit from 1993 to 1997 were contacted and interviewed about typical seizure frequency and distribution and history of CSE. Seizure clustering was defined as three or more complex partial seizures within a 24-h period, with return to baseline between seizures. RESULTS: Of the 76 patients contacted, 21 (28%) had experienced at least one episode of CSE, and 36 (47%) typically experienced clustered seizures. SE occurred in 16 (44%) of 36 patients with clustered seizures, and in five (12.5%) of 40 patients with nonclustered seizures (p < 0.002). Of 53 patients with temporal lobe epilepsy, CSE occurred in 13 (50%) of 26 patients with clustered seizures, and four (14.8%) of 27 patients with nonclustered seizures (p < 0.006). CONCLUSIONS: Patients with intractable complex partial or localization-related epilepsy who typically experience seizure clustering are at a significantly higher risk for CSE than are patients with nonclustered seizures.     

立体脑电图引导外科治疗颞岛型颞叶癫痫附加症

目的探讨立体脑电图(SEEG)引导外科手术治疗颞岛型颞叶癫痫附加症(TPE)的安全性及疗效。方法回顾性分析广东三九脑科医院癫痫中心2014年5月至2015年11月经SEEG证实的颞岛型TPE患者的临床资料,共纳入10例(占同期147例颞叶癫痫手术患者的6.8%)。所有患者在立体定向辅助机器人引导下植入SEEG电极,综合定位评估后行致痫灶切除手术,切除范围包括前颞叶、颞叶内侧结构及岛叶致痫皮质。随访观察手术疗效。结果每例患者植入电极9~16根,平均(12.4±2.1)根。其中7例为颞岛同步型,3例为颞岛独立型。术后仅1例出现短暂命名性失语,在出院前恢复,其余患者无手术相关并发症。术后随访时间为18~36个月,平均(28±6)个月。全部患者均达Engel分级Ⅰ级(Ⅰa级9例,Ⅰc级1例)。结论SEEG是明确诊断颞岛型TPE的重要方法;在SEEG的引导下,外科治疗颞岛型TPE安全、有效。     

以癫痫为首发症状的颞叶海绵状血管畸形的手术治疗方式

目的探讨以癫痫为首发症状的颞叶及颞叶内侧海绵状血管畸形的手术治疗方式。方法回顾性分析广东三九脑科医院2009~2013年手术治疗的49例以癫痫为首发症状的颞叶及颞叶内侧海绵状血管畸形患者,其中全面性强直-阵挛性发作26例,复杂部分性发作23例,20例行单纯病灶切除(A组),29例根据术中脑电监测结果,病灶及颞叶及/或内侧结构癫痫灶扩大切除术(B组)。结果采用Engel效果分级,A组中Ⅰ级为70%,Ⅱ级为20%,Ⅲ级10%;病理检查均为海绵状血管畸形。B组中Ⅰ级89.66%,Ⅱ级6.9%,Ⅲ级3.44%;病理检查为海绵状血管畸形,其中25例包括海马硬化,3例皮质发育不良。术中及术后均无明显并发症及死亡患者。结论对以癫痫为首发症状的颞叶海绵状血管畸形患者,通过积极的手术治疗可有效控制癫痫发作。结合术前及术中脑电结果,采用选择性扩大切除癫痫灶,对控制癫痫更为有效。颞叶及颞叶内侧海绵状血管畸形患者可能存在双重病理改变。     

Long-term seizure outcome and its predictors in patients with recurrent seizures during the first year aftertemporal lobe resective epilepsy surgery

Purpose: The existing data on the implications of the characteristics of seizures that recur during the first year following epilepsy surgery on subsequent seizure outcome are conflicting. We investigated the impact of recurrent seizures in the first postoperative year and their attributes on long‐term seizure outcome. Methods: We studied the postoperative courses of 492 patients who had completed two or more years of follow‐up after temporal lobe resective epilepsy surgery. We used Kaplan‐Meier survival curves to define long‐term seizure outcome and assessed the predictive value of recurrent seizure characteristics on the outcome by univariate and multivariate proportional hazards regression models. Key Findings: In our patients, seizure recurrences during the first postoperative year, irrespective of the attributes of recurrent seizures (such as provoked vs. unprovoked, and timing and number of recurrences), imparted fourfold to sevenfold increased hazards for continued seizures beyond the first postoperative year. Although patients with complex partial seizures with or without secondary generalized tonic–clonic seizures (CPS/GTCS) had a sixfold increased risk, those with auras alone had only a borderline risk for seizures beyond the first postoperative year. In the multivariate model, CPS/GTCS as the predominant seizure type and three or more seizure recurrences during the first postoperative year independently predicted unfavorable long‐term seizure outcome. Significance: Our study provides valuable information that is helpful in prognosticating and counseling patients, and in making rational decisions on the withdrawal of antiepileptic drugs following surgery. Our findings enhance the general understanding of the etiopathogenesis of surgical failure.