长程视频脑电图及颅内电极脑电图监测在颞叶癫痫手术中的作用

目的：长程视频脑电图及颅内电极脑电图监测在颞叶癫痫手术中的作用。方法：本文选取我院于2013年08月-2014年08月收治的36例颞叶癫痫手术患者,对其分别在术前实施长程视频脑电图诊断检测过程和术中实施颅内电极脑电图诊断检测过程,对比两种不同脑电图检测方式的诊断效果。结果：采用长程视频脑电图诊断方式对患者的病灶检出率为83．33％,采用颅内电极脑电图诊断方式对患者的病灶捡出率为100.00％,两组结果对比存在显著性差异（P〈0．05）,具有统计学意义。结论：颞叶癫痫手术患者在手术过程中采用长程视频脑电图及颅内电极脑电图两种不同的脑电图诊断方式开展检测能够能够有效的进行术前和术中定位,对于提高手术的成功实施有着重要作用,值得在临床中推广应用。     

病灶性难治性癫痫术前评估及手术方法的探讨

目的 探讨病灶性难治性癫痫术前评估和手术治疗的方法.方法 对40例病灶性难治性癫痫患者联合应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行术前评估,确定致痫灶与病灶的关系,采用单纯病灶切除术、病灶切除加周围皮质切除术、病灶切除加周围皮质软膜下横切术或皮层热灼术等手术方法,随访复查,评价临床效果.结果 40例患者术前评估致痫灶与病灶位置基本一致,术中均应用皮层电极监测,与术前评估相符.术后随访11～48 个月,Engel Ⅰ级30例(75.0%),Ⅱ级7例(17.5%),Ⅲ级2例(5.0%),Ⅳ级1例(2.5%).36例(90%)患者生活质量改善.结论 病灶性难治性癫痫,术前需应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行评估以明确病灶与致痫灶的关系,采用多种手术方法联合的方法是治疗病灶性难治性癫痫的有效途径.     

氟比洛芬酯用于瑞芬太尼麻醉术后镇痛的临床研究

目的探讨病灶性难治性癫痫术前评估和手术治疗的方法。方法对40例病灶性难治性癫痫患者联合应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行术前评估，确定致痫灶与病灶的关系，采用单纯病灶切除术、病灶切除加周围皮质切除术、病灶切除加周围皮质软膜下横切术或皮层热灼术等手术方法，随访复查，评价临床效果。结果40例患者术前评估致痫灶与病灶位置基本一致，术中均应用皮层电极监测，与术前评估相符。术后随访11～48个月．EngelⅠ级30例（75．0％），Ⅱ级7例（17．5％），Ⅲ级2例（5．0％），Ⅳ级1例（2．5％）。36例（90％）患者生活质量改善。结论病灶性难治性癫痫，术前需应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行评估以明确病灶与致痫灶的关系，采用多种手术方法联合的方法是治疗病灶性难治性癫痫的有效途径。     

经尿道前列腺电切术78例围手术期护理

目的:探讨经尿道前列腺电切术手术患者围手术期的护理。方法:对78例经尿道前列腺电切术手术患者根据其身心特点,实施切实可行的围手术期护理措施,观察病情变化,加强管道护理。结果:本组患者78例患者均治愈出院。结论:加强围手术期患者的心理护理和术前准备,术后严密观察病情,及时采取有效的护理措施,有助于提高患者的治疗效果和减少术后并发症的发生。     

癫痫患者行长程视频脑电监测的安全护理

目的探讨在癫痫患者行长程视频脑电监测时给予安全知识宣教和有效的安全护理措施的价值。方法选取南京医科大学附属脑科医院功能神经外科2017年5月至2018年5月门诊和住院的1 112例癫痫或疑似癫痫发作的患者进行视频脑电监测,按照随机数字表将患者随机分为对照组和试验组,每组各556例。对照组实施常规视频脑电监测护理;试验组监测过程中除常规护理外,同时加强安全知识宣教,并在监测过程中实施安全护理措施。结果试验组通过强化的安全护理措施,长程视频脑电监测完成率高于对照组(P0. 05)。结论做好癫痫患者的安全知识宣教,实施有效的安全防护及护理措施,是患者安全及顺利完成监测检查的重要保证。     

视频脑电图对间歇期痫样放电的应用效果及对检出率的影响

目的：探究视频脑电图对间歇期痫样放电的应用效果及对检出率的影响。方法：以2020年1月～2022年12月本院收治的60例癫痫患者为研究对象,随机数表法分组,对照组（n=30例）单纯实施常规脑电图监测,观察组（n=30例）单纯实施长程视频脑电图监测,同时进行闪光刺激试验、睁闭眼诱发试验以及过度换气诱发试验,并对两组受试者的癫痫样放电检出率及诊断准确率进行记录。结果：观察组癫痫样放电的检出率为50%,而对照组的检出率为27%,两组之间存在显著统计学差异（P<0.05）;观察组诊断准确率为63.33%,对照组诊断准确率为33.33%,两组之间具有显著统计学差异（P<0.05）。结论：视频脑电图监测能提高间歇期痫样放电的检出率,有助于提高诊断准确性,具有较高的应用效果。     

颈段食道癌胃代食道胃咽吻合术围手术期护理

目的：总结颈段食道癌患者围手术期的护理措施。方法：对12例手术病人进行护理，主要包括术前做好心理护理、营养支持、呼吸道准备、术前准备；术后做好体位护理、严密观察病情、饮食护理、口腔护理；出院指导等。结果：12例患者均康复出院。结论：颈段食道癌患者手术范围广，术后容易发生咽瘘、切口感染等并发症。科学的围手术期护理是保证手术治疗成功、预防和减少术后并发症的重要保证。     

肺癌合并糖尿病的围手术期护理

目的总结肺癌合并糖尿病患者的围手术期护理方法。方法重视肺癌合并糖尿病患者的术前血糖控制,心理疏导及营养教育,术后加强生命体征观察及血糖监测,加强管道护理及提高术后患者合并症,并发症的护理水平。结果 47例患者应用综合性护理措施降低了手术风险,减少并发症的发生,无1例患者围手术期死亡。结论加强肺癌合并糖尿病患者的围手术期护理可促使患者顺利康复,提高其生活质量。     

巨大肝血管瘤腹腔镜手术治疗11例围手术期的护理

目的 探讨腹腔镜手术治疗巨大肝血管瘤围手术期的护理措施.方法 11例巨大肝血管瘤行腹腔镜手术切除,术前做好患者心理护理和各项术前准备,术后监测患者血压、体温和腹腔引流量变化,做好切口部位的护理,防止并发症的发生.结果 全组术后病情平稳,恢复良好,无手术并发症,无手术死亡病例.术后顺利出院.结论 良好的围手术期护理措施有助于提高腹腔镜巨大肝血管瘤切除术的治疗效果和成功率.     

30例颅内动脉瘤弹簧圈栓塞术的围术期护理

目的：探讨30例应用弹簧圈行颅内动脉瘤栓塞术治疗蛛网膜下腔出血的护理。方法：对患者实施合理、细致的术前、围手术期、术后护理,预防并发症的发生。结果：30例患者手术均成功,术后并发脑血管痉挛2例,经临床治疗康复出院,未发生与护理不当相关的并发症。结论：合理完善的护理措施有助于提高治疗效果,减少并发症、致死率及致残率,促进患者的康复。     

难治性癫痫手术联合免疫治疗前后体液免疫状况调查

目的:回顾性分析难治性癫痫患者手术联合免疫治疗前后的体液免疫水平。方法:对43例难治性癫痫患者分别采取相应手术方式进行治疗,术后遵循个体化原则服用抗癫痫药,并联合胸腺肽进行治疗,随访3-6个月,采用ELISA法及速率散射浊度法对术前、术后一周、术后三个月及半年的血清免疫球蛋白及补体水平进行检测比较。结果:①临床疗效:手术后12例终止发作,13例显效,10例有效,5例效差,3例无效,海马硬化者手术效果好。②体液免疫检测结果:癫痫患者免疫球蛋白(IgA、IgG)及补体C3水平于术后一周低于术前(P﹤0.01),海马硬化者明显,术后三个月至半年逐渐升高,且明显高于术前水平。IgM及C4在手术前后无明显变化。结论:难治性癫痫患者免疫功能低下或紊乱,手术联合免疫治疗能有效控制或减少癫痫发作并有助于改善患者免疫功能。     

The neurosurgical treatment of epilepsy

Despite the new advancements in antiepileptic drug development, thousands of people with epilepsy will remain intractable to medication. For a considerable proportion of these people, epilepsy surgery is a consideration for better control of their seizures. Resective surgery is now standard practice for patients with medication-refractory epilepsy. Temporal lobectomy continues to be the most common surgery performed. Once patients fail 2 to 3 optimal trials of antiepileptic medication, further drug therapy offers a minimal number of patients freedom from seizures. In contrast, temporal lobectomy in carefully selected patients may result in seizure-free outcomes in more than 70% to 90% of patients with intractable seizures. As technology and drug availability increases in the new millennium, it is important for the primary care physician to be aware of epilepsy surgery as a means to treat patients with antiepileptic drug-refractory epilepsy. Arch Fam Med. 2000;9:1142-1147     

Surgical successes and failures of invasive video-EEG monitoring in the presurgical evaluation of epilepsy

Invasive monitoring with intracranial electrodes continues to play a critical role in the presurgical evaluation of patients with medically intractable epilepsy. Intracranial monitoring helps in localizing the epileptogenic zone and can be used to delineate eloquent cortical areas adjacent to this zone. In this review we analyzed surgical successes and failures of invasive video-electroencephalography (EEG) monitoring. Thorough understanding of all potential complications is of paramount importance not only for detection and successful management of intractable epilepsy but also for medicolegal purposes, as patients and their relatives need to be fully informed about the possible risks associated with invasive monitoring. A mortality rate between 0.5% and 2.8% has been reported. Cerebrospinal fluid (CSF) leaks and infections are the most frequent complications, with an incidence ranging from 0-31.3% and from 0-17.4%, respectively. The incidence of intracranial hemorrhage is reported to be up to 14% with subdural hematomas being the most prevalent. Epidural hematomas are less frequent and encountered in up to 2.6% of cases. Intraparenchymal hematomas are even less frequent and are typically associated with the placement of depth electrodes. In 47-98% of cases, invasive video-EEG monitoring results into resective surgery. Invasive video-EEG monitoring is a reasonably safe and effective method to help delineate the epileptogenic zone and its relation to eloquent cortex.     

Risk factors for intractable pleural effusion after liver resection

BACKGROUND: Although intractable pleural effusion is a well-known complication after liver resection, risk factors for this condition have not been established. METHODS: Records of 254 patients who underwent liver resection for hepatocellular carcinoma between January 1994 and December 2002 were reviewed. Postoperative pleural effusion that required thoracentesis or continuous drainage with or without pleurodesis was defined as intractable. Variables evaluated as risk factors included demographic factors, presence of cirrhosis, routine preoperative laboratory data, serum concentration of type IV collagen 7S domain (7S collagen), Child-Pugh class, preoperative interventions, including transcatheter arterial embolization (TAE), operative procedure, intraoperative blood loss, histology of noncancerous hepatic parenchyma, and major postoperative complications. RESULTS: Postoperative intractable pleural effusion developed in 15 (5.9%) patients. Serum concentration of 7S collagen, preoperative transcatheter arterial embolization (TAE), and liver resection that included segments 7 and/or 8 were independent risk factors on multivariate analysis. In patients with high concentration of 7S collagen (> or = 8.0 ng/mL), the incidence of the complication was significantly lower in patients who had not undergone TAE than in those who had undergone TAE. CONCLUSION: An increase in serum 7S collagen concentration (> or = 8.0 ng/mL) and preoperative TAE are independent and preoperative risk factors for the development of intractable pleural effusion after liver resection for HCC. Preoperative TAE should be avoided when possible in patients whose serum 7S collagen concentration is > or = 8.0 ng/mL.     

颞叶海马硬化所致的难治性癫痫外科手术治疗与GAMMA刀治疗临床分析

[目的]探讨颞叶海马硬化所致难治性癫痫采用外科手术治疗与GAMMA刀治疗的疗效及治疗费用。[方法]本文通过1998～2003年在我研究所就诊的颞叶海马硬化所致的难治性癫痫患者进行评估后根据患者意愿分别给予外科手术治疗与GAMMA刀治疗。[结果]外科手术组治疗近期疗效92.8%,GAMMA刀治疗近期疗效53.84%,外科手术组平均治疗费用8500元（人民币）,GAMMA刀治疗组平均治疗费用18000元（人民币）。[结论]外科手术治疗与GAMMA刀治疗颞叶海马硬化所致的难治性癫痫安全有效,外科手术治疗近期疗效优于GAMMA刀治疗,但平均治疗费用低于GAMMA刀治疗。     

Mesial temporal lobe epilepsy. Nine case reports

INTRODUCTION: Mesiotemporal epilepsy (MTLE) is a clinical syndrome characterised by the association of a history of febrile seizures, a homogenous clinical presentation of seizures, temporal interictal and ictal EEG recordings and an underlying pathology that is mesial sclerosis. MTLE is the most common type of medically intractable partial epilepsy with a drug-resistance in 90% of cases. OBJECT: The aim of this study is to describe the clinical, EEG and MRI findings of 9 patients with MTLE attending the outpatient clinic of Charles Nicolle Hospital. RESULTS: The median age of our study population was 30 years. A history of febrile seizures was found in 5 patients. Hippocampal atrophy was found in all the cases right in 4 cases and left in 5 cases. Drug-resistance was observed in 7 patients. No patient underwent surgery. CONCLUSION: It is important in front of medically intractable partial epilepsy to evoke MTLE, to confirm the diagnosis with neuro-imaging and to propose an interdisciplinary therapeutic approach including neurologists, epileptologists and neurosurgeons.     

Use of the ketogenic diet and dietary practices in the UK

Background: In 2000, a survey showed that use of the ketogenic diet as a treatment for intractable epilepsy in the UK was low. Subsequently, the number of medical publications supporting its efficacy has increased and demand from parents for this treatment has also increased. This survey was undertaken to determine whether there had been an increase in the use of the ketogenic diet and the necessary resources to provide it. Methods: A survey of paediatric dietitians in the UK was undertaken. Data were collected on their experience of implementing a ketogenic diet, the type of diet used, patient caseloads, other members of the care team, the process for initiation of the diet and funding. Results: Twenty‐eight hospitals offered the ketogenic diet treatment with a total of 152 patients. The caseload per dietitian ranged from 1–36 patients. The classical diet was prescribed for 74% cases. The majority of patients began the diet as outpatients. Six dietitians were specifically funded to provide the treatment. Fifty more dietitians had experience of implementing the diet but currently had no patients. The reasons given for this were no referrals, no funding or not working with patients with epilepsy. Conclusions: The number of patients on the ketogenic diet had increased since 2000. However, numbers remained low and the main reasons given were the lack of referrals and a lack of funding. Recommendations are made to improve the dietetic and funding resources available so that an efficacious treatment for intractable epilepsy of childhood can be made more widely available.     

Surgically treatable epilepsy--a review

20-25% of epileptic patients do not become seizure free on adequate drug therapy. In 25-50% of patients with intractable epilepsy, the brain area responsible for seizures is well localizable and does not involve eloquent regions. In these patients, the surgical excision of the epileptic focus may lead to relief from seizures. In Hungary, there may be 5-6000 patients who needs an epilepsy surgery, but till now only 200 patients with chronic epilepsy underwent a surgical procedure. In the surgically remediable epilepsies, the operation is not a "ultima ratio". Concerning these syndromes, if 2-3 adequate antiepileptic drugs do not lead to seizure freedom within 1-3 years after the epilepsy onset, then a presurgical evaluation is necessary. The most common surgically remediable epilepsy is the temporal lobe epilepsy in which 60-90% of drug-resistant patients could be surgically cured. In lesional neocortical epilepsies 50-80% of patients become postoperatively seizure free. In childhood hemispheric epilepsies, the surgery could lead to seizure freedom in 70-80% of patients. The basic tools of the presurgical evaluation are the detailed history, the high resolution-MRI, the video-EEG monitoring, and the neuropsychological assessment. These investigation methods are usually enough to evaluate the necessity of the surgery and the postoperative outcome as well as to plan the localization and the extension of the resection. In some cases, ictal SPECT, PET, or video-EEG monitoring with intracranial electrodes could also be necessary in order to localize the epileptic focus.     

Nutrient intake of children with intractable epilepsy compared with healthy children

Growth retardation is common among children with epilepsy, and poor dietary intake may be one of the causes. The goal of this cross-sectional study was to compare the nutrient intake of children 1 to 8 years of age with intractable epilepsy to healthy children of the same age from the National Health and Nutrition Examination Survey 2001 to 2002 (N=1,718) and with the Dietary Reference Intakes. Children with intractable epilepsy were divided into two age groups: 1.0 to 3.9 and 4.0 to 8.9 years, to correspond with the Dietary Reference Intakes. Forty-three children with intractable epilepsy, mean age=4.7+/-2.2 years, had significantly lower intakes (P<0.05) of total energy; protein; carbohydrate; fat; dietary fiber; vitamins A, E, B-6, and B-12; riboflavin; niacin; folate; calcium; phosphorus; magnesium; zinc; copper; and selenium compared with healthy children. Thirty percent or more of the children with intractable epilepsy in both age groups had intakes below the Recommended Dietary Allowance or Adequate Intake for vitamins D, E, and K; folate; calcium; linoleic acid; and alpha-linolenic acid. Health care professionals caring for children with intractable epilepsy should be aware of this pattern of decreased nutrient intake and educate families to provide an adequate diet and/or consider vitamin/mineral supplementation.     

脑电视频监测在癫痫诊断中的应用

目的通过脑电视频监测提高对癫痫诊断的阳性率。方法来源于我院247例诊断为癫痫患者的12～24h视频脑电监测,分析临床发作率与痫样放电率的关系。结果本组在247例癫痫病人中,脑电图正常的27例,占10.9%,边缘状态23例,占9.3%,轻度异常40例,占16.2%,中度异常为144例,占58.3%,重度异常13例,占5.3%,总异常率为89.1%。痫样放电167例,占67.6%;临床发作23例,占9.3%。结论脑电视频监测可全面系统的观察病人的脑电活动和临床表现,并可了解两者之间的关系,及时对各种发作性疾病作出诊断,提高对癫痫诊断的阳性率。