立体定向杏仁核海马毁损治疗颞叶癫痫

目的探讨立体定向杏仁核海马毁损治疗颞叶癫痫的原理、方法和疗效。方法患者头部安装MD～2000立体定向框架。使其平行于颞角长轴。针对12例颞叶顽固性癫痫患者,应用头部MRI扫描定位,局麻下深部电极行杏仁核及海马脑电监测和射频毁损术。结果射频毁损前12例患者深部电极均记录到杏仁核和海马区棘波、尖波或多棘波,术后显示痴样放电消失。术后随访9～18个月．癫痫发作完全控制者58．3％（7／12）,显著改善33．3％（4／12）。结论立体定向杏仁核海马毁损术治疗颞叶顽固性癫痫是一种安全有效的微创治疗方法,值得临床推广。     

立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的临床研究

目的 探讨立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的有效性,同时评价深部电极记录的发作间歇期痫性放电定位致痫灶的准确性. 方法 选择南方医院神经外科门诊自1998年7月至2003年10月收治的21例顽固性颞叶癫痫患者,行立体定向杏仁核海马毁损术.术中在毁损靶点前后行深部电极记录,统计发作间歇期痫性放电发生频率. 结果 术后随访21例,其中EngelⅠ级6例,Ⅱ级2例,Ⅲ级5例,Ⅳ级3例,Ⅴ级5例.有效者(Ⅰ+Ⅱ+Ⅲ级)13例,无效者(Ⅳ+Ⅴ级)8例,有效率为62％.深部电极记录的发作间歇期痫性放电手术前后的发生频率差异无统计学意义(P＞0.05). 结论 立体定向射频毁损杏仁核海马手术治疗颞叶内侧型癫痫安全有效.深部电极记录的发作间歇期痫性放电定侧价值较高,而定位价值低.     

立体定向杏仁核海马毁损治疗颞叶癫癎

目的 探讨立体定向杏仁核海马毁损治疗颗叶癫(癎)的原理、方法 和疗效.方法 患者头部安装MD-2000立体定向框架,使其平行于颞角长轴.针对12例颗叶顽固性癫(癎)患者,应用头部MRI扫描定位.局麻下深部电极行杏仁核及海马脑电监测和射频毁损术.结果 射频毁损前12例患者深部电极均记录到杏仁核和海马区棘波、尖波或多棘波,术后显示(疴)样放电消失.术后随访9～18个月,癫(癎)发作完全控制者58.3%(7/12),显著改善33.3%(4/12).结论 立体定向杏仁核海马毁损术治疗颞叶顽固性癫(癎)是一种安全有效的微创治疗方法 ,值得临床推广.     

国产机器人Remebot定位植入颅内深部电极并实施海马杏仁复合体射频热凝毁损术治疗顽固性癫痫1例

目的验证国产机器人导航定位系统Remebot的有效性与安全性。方法临床选择1例顽固性癫痫患者,头皮脑电显示为多灶异常痫性放电。首先分别以双颞叶内侧为靶点,左侧分别经额、经颞叶外侧放置2枚深部电极,右侧经额放置1枚深部电极。经长程SEEG监测提示左侧海马杏仁复合体为致痫主灶。1周后以左颞叶内侧为靶点,分别经额与经顶枕交叉射频热凝海马杏仁复合体。结果颅内电极埋置后行CT复查,显示电极安放位置与手术计划相符,误差小于2mm,长程SEEG监测捕捉到临床发作一次,提示为左颞内侧起源。实施左侧海马杏仁复合体热凝术后患者癫痫发作明显减少,复查MRI提示毁损位置准确无误。结论国产机器人导航定位系统Remebot不仅可以实施立体定向颅内深部电极植入手术,还可对脑内深部致痫灶实施精准毁损手术,在癫痫的外科诊治领域有着广阔的应用前景。     

脑立体定向植入海马电极监测颞叶内侧癫痫的临床研究

目的 观察应用脑立体定向微创穿刺技术植入海马电极监测颞叶内侧癫痫的效果.方法 13例耐药性颞叶内侧癫痫患者,主要表现为复杂部分性癫痫发作及继发性全身强直阵挛性发作.根据临床症状、MRI等资料初步确定癫痫灶位于海马区域,在脑立体定向仪引导下于双侧海马植入8-触点深部电极,监测24 ～ 72 h,从而确认癫痫灶是否位于海马区域.结果 13例患者经过72 h监测,共监测到7例有29次临床发作,发作期脑电变化表现为在背景波形基础上出现阵发性高幅慢波或棘尖慢复合波,从某个电极点开始,迅速扩展到同侧其他电极点甚至对侧电极;头皮脑电在延迟1～2s后出现3～4 Hz的高幅δ节律.6例未监测到临床发作的患者,海马电极监测到发作性局灶性高幅慢波或尖慢综合波,而头皮电极未监测到明显异常.13例患者中6例接受选择性海马杏仁核切除或立体定向病灶损毁术,随访3～8个月,效果满意.结论 脑立体定向植入海马电极监测颞叶内侧癫痫是一种安全可靠的方法,可以判断癫痫病灶的起源,为外科进行选择性海马杏仁核切除提供有力依据,对于视频脑电图或其他手段难以记录到癫痫样波形或难以判断癫痫样放电起源的患者可进行脑立体定向深部电极脑电图监测.     

长程颅内电极记录定位致痫灶的效果分析

目的 讨论应用颅内埋藏电极进行长程视频脑电(Video-EEG)监测，对于致痫灶的定位作用。方法 应用立体定向技术，向颅内可疑部位植入深部电极和／或硬膜下条状电极。采用DaVinci系统，进行长程视频脑电监测，记录发作间期及发作期EEG变化，确定癫痫起源部位。在皮层电极脑电图(ECoG)监测下，手术切除致痫灶或行立体定向毁损术。结果 本组17例患者颅内电极埋藏时间4～17天，平均9天。各例均记录到明确的发作间期异常放电和／或发作期EEG变化。手术切除致痫灶16例(联合胼胝体切开术1例)；行双侧杏仁核毁损术1例。术后复查Vidoo-EEG，显示痫性放电基本消失15例，改善2例(集中于手术对侧1例)。按照Engel术后效果分级：Ⅰ级15例，Ⅲ级1例，Ⅳ级1例。所有病例均未出现因长时间埋藏颅内电极引起的并发症。结论 在致痫灶定位困难的难治性癫痫患者中，应用埋藏式颅内深部电极和／或硬膜下条状电极，进行长程颅内电极记录，可以精确定位致痫灶，可改变外科治疗计划，从而提高了癫痫的治愈率及手术成功率。     

快速点燃海马杏仁核建立癫痫鼠模型

目的：快速建立实验性癫痫动物模型。方法 １７只大鼠右侧海马和１１只鼠右侧杏仁核均埋植电极,用ＩＳ－２型智能刺激器,以２００－６００μＡ电脉冲刺激点燃海马杏仁核。结果 电刺激可诱发痫性发作和后放电,痫性行为分为五级,后放电呈高幅棘波。在过程中,可记录到两种脑电活动：痫性脑电活动和自发性痫性脑电活动。随着电刺激次数的增多,发现Ⅱ、Ⅲ级痫性行为伴随较短的后放电时程,Ⅳ级上以痫性行为伴随较长的后放电时程。     

脑电偶极子分析在痫灶切除术中的定位价值

目的探讨长程视频脑电监测和偶极子分析在痫灶切除术中的定位价值。方法对35例开颅痫灶切除术患者术前行常规脑电和长程视频脑电监测,脑电痫性放电进行偶极子分析,并与手术中硬膜下电极记录的脑电相对照。结果35例患者视频脑电图监测异常35例,有痫性放电者35例;常规脑电图异常28例,有痫性放电者18例;行常规脑电图监测无典型癫痫发作出现。两者之间脑电异常率、痫性放电阳性率、典型临床发作率都有统计学意义。以术中硬膜下电极记录为标准,头皮脑电偶极子定位异常放电灶的准确率为97%,切除病灶病理检查异常率86%。偶极子定位误差一般<15mm。结论长程视频脑电监测和头皮脑电偶极子定位癫痫起源灶可为开颅痫灶切除手术提供有价值的信息。     

耐药性颞叶内侧癫痫发作前期海马脑电特征分析

目的 观察耐药性颞叶内侧癫痫患者发作前期海马电极脑电活动特点,为判断和切除癫痫病灶提供神经电生理学依据.方法 对16例非侵入性手段难以明确病灶的耐药性颞叶内侧癫痫患者进行双侧海马电极监测,患者停用抗癫痫药在非麻醉状态下监测48～72 h,分析癫痫发作前期海马电极脑电图资料,探讨耐药性颞叶内侧癫痫发作前期海马电极脑电活动特点.结果 16例发作间期记录到背景活动基础上出现局限于某几个电极点的阵发性高幅慢波1例、发作性快波节律1例、棘波或棘尖慢复合波14例,视为异常脑电活动;经过48～ 72 h监测,10例监测到33次临床癫痫发作,发作起始期海马电极均可记录到清晰可辨的癫痫样脑电波形.结论 颞叶内侧癫痫临床发作起始期海马电极癫痫样放电清晰可辨,部位局限,易于确定癫痫性活动起源部位.对于非侵入性手段难以判断癫痫样放电起源的颞叶内侧癫痫可采用脑立体定向技术植入海马深部电极进行脑电监测.     

毫针蝶骨电极在癫痫诊断中的应用

目的探讨毫针蝶骨电极在癫痫诊断中的应用价值及常规脑电图加用蝶骨电极的指征。方法102例临床诊断为癫痫的患者于发作间期行常规脑电图及毫针蝶骨电极脑电图描记,分别对其癫痫波的检出率进行分析。结果经χ2检验分析,蝶骨电极脑电图可提高全身强直-阵挛发作、单纯部分性发作、复杂部分性发作3种发作类型癫痫的痫样放电检出率,其中以复杂部分性癫痫尤为显著;此外发现43例常规脑电图描记时耳垂单极导联可见单侧或双侧正相尖（棘）波或正相尖（棘）慢波,而在蝶骨电极描记时均记录到明显的癫痫波。结论蝶骨电极可提高癫痫患者的痫样放电检出率,常规脑电图描记发现耳垂单极导联出现正相尖（棘）波或正相棘（尖）慢波,加用蝶骨电极多可记录到典型的癫痫波,具有临床确诊价值,应列为临床脑电图的常规描记方法。     

Value of long-term electroencephalogram in diagnosing epilepsy

BACKGROUND: Routine electroencephalogram (EEG) usually cannot accurately reflect the discharge of epileptic patients due to the short examination, and long-term EEG can make up the shortcoming. OBJECTIVE: To comparatively analyze the long-term EEG of epileptic and non-epileptic patients, and investigate the values of long-term EEG in the diagnosis and differential diagnosis of epilepsy. DESIGN: A case-controlled study. SETTING: Ningjin County People's Hospital. PARTICIPANTS: Totally 122 patients with epilepsy (epilepsy group) were selected from the EEG room of Ningjin County People's Hospital from January 2000 to December 2006, including 76 males and 44 females, 7 months to 78 years of age, the disease course ranged from 7 days to 7.5 years, and they all according with the standards for epilepsy set by the International Association for Epilepsy in 1997. Meanwhile, 118 patients with non-epileptic paroxysmal diseases were selected as the control group, including 71 males and 47 females, 2.5–87 years of age, the disease course ranged from 3 days to 7.5 years. Informed contents were obtained from all the subjects. METHODS: OXFORD GATE WAY 2000 16-lead portable EEG recorder was used for 24-hour electroencephalographic procedure. The patients could move normally during the monitoring, their activities, sleeping conditions, time and manifestations of seizures were recorded in details. In the next day, EEG at wake was recorded for 10 minutes, followed by 3-minute hyperventilation and open/close eye induction test, the phases of non-rapid eye movement (Ⅰ–Ⅳ) and rapid eye movement were performed using EEG at sleep according to the international EEG standard. The abnormal rates of EEG epileptic discharge at wake and sleep at different sites were calculated. MAIN OUTCOME MEASURES: Abnormal rate of long-term EEG at wake and sleep in both groups; Epileptic discharge at different sleeping phases in both groups; Abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group. RESULTS: All the 122 patients with epilepsy and 118 patients with paroxysmal diseases were involved in the final analysis of results. ① Comparison of abnormal rate of long-term EEG at wake and sleep: In the epilepsy group, the abnormal rate of EEG at wake was obviously lower than that at sleep (68%, 91%, P < 0.01). In the control group, the abnormal rate of EEG at wake and sleep had no obvious difference (P > 0.05). ② Results of epileptic discharge at different sleeping phases: In the epilepsy group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 88.1%, and at Ⅲ–Ⅳ in 11.9%; In the control group, the epileptic discharge occurred at Ⅰ–Ⅱ phases of sleep cycle in 91.7%, and at Ⅲ–Ⅳ phases in 8.3% (1/12). ③ Comparison of the abnormal rates of EEG epileptic discharge at wake and sleep at different sites in the epilepsy group: The abnormal rates of epileptic discharge at frontal lobe and temporal lobe at sleep were obviously higher than those at wake (21.3%, 24.6%; 10.7%, 11.7%, P < 0.01), while there were no obvious differences at wake and sleep at occipital lobe, parietal lobe (P > 0.05). CONCLUSION: Long-term EEG has great importance in the diagnosis and differential diagnosis of epilepsy, especially that it increases the detective rate of discharge by several cycles of sleep derivation. This method also provides important reference for the allocation of epileptic focus.     

Infantile epileptic encephalopathy with late‐onset spasms: Report of 19 patients

Purpose: Late‐onset spasms (LOS) are epileptic spasms starting after the first year of life. Our aim was to assess the electroclinical features and the follow‐up of the patients with this particular type of epileptic seizure. Methods: We retrospectively included all patients with LOS confirmed by electroencephalography between 1989 and 2008. Clinical and electroencephalographic findings at diagnosis and during follow‐up were collected. The Vineland scale was used to evaluate the neuropsychological outcome. Results: We report 19 patients with LOS of 240 patients with recorded epileptic spasms. Eighteen patients had an epileptic encephalopathy with late‐onset spasms. The ictal electroencephalography (EEG) showed a focal or generalized discharge of triphasic slow‐waves, slow‐spikes, or slow spikes‐waves with fast activities. The interictal EEG usually showed focal or generalized slow‐waves or slow spikes‐waves without hypsarhythmia. LOS were controlled in only six patients. Three developed typical Lennox‐Gastaut syndrome and 10 had a severe epileptic encephalopathy. Neuropsychological outcome was evaluated in 15 patients with the Vineland scale. Cognitive functions were normal in only one patient, whereas severe cognitive delay was observed in 12 of 15. Conclusion: Epileptic spasms may appear after the age of one. They are more frequently observed in patients with epileptic encephalopathy. In few patients this type of seizure was observed before the patients fulfill Lennox‐Gastaut syndrome criteria. In one patient, we diagnosed a focal epilepsy with seizures occurring in cluster. When LOS are related to an epileptic encephalopathy, this epileptic syndrome seems to be linked to refractory epilepsy and severe cognitive outcome unrelated to the etiology.     

长程视频脑电监测对癫痫间的诊断价值

目的 评价长程视频脑电图对癫痫间等发作性疾病的诊断价值,提高癫痫间及癫痫间综合征的诊断。方法 对在本院神经内科癫痫间中心门诊及住院患者中首次以发作性疾病就诊的患者进行不同时程的视频脑电图监测,对其临床资料进行回顾性分析。结果 24 h组视频脑电监测对癫痫间异常脑波放电的阳性检出率较高(76.9%),8 h组最低(30.1%),15 h组介于两者之间(55.4%),在24 h组1920例患者中有1476例有异常放电,287例记录到临床同步发作,其中153例明确癫痫间发作类型,153例中96例进一步明确为癫痫间综合征,使对癫痫间的分型及癫痫间综合征的分类更加明了细化。结论 24 h视频脑电监测能够显著提高癫痫间患者的诊断率及异常脑波的检出率,有效地降低了假阴性率并且在癫痫间的鉴别诊断、分型及癫痫间综合症的诊断方面有重要的临床意义,同时对其他发作性疾病的鉴别提供了可靠的的临床依据。     

27例学龄前难治性颞叶癫痫患儿临床报道

目的探讨学龄前难治性颞叶癫痫患儿影像学、电生理特点及手术方法和疗效。方法回顾性分析解放军联勤保障部队第九八八医院神经外科中心自2014年6月至2019年1月行手术治疗的27例学龄前难治性颞叶癫痫患儿资料,术前评估结合临床发作表现,MRI、磁共振波谱分析(MRS)、正电子发射断层扫描(PET-CT)等影像资料,以及发作间期和发作期视频脑电图(VEEG)资料;术中应用皮层脑电图(ECoG)与深部电极监测定位异常放电区域,指导手术切除致痫灶范围。术后采用Engel分级评估疗效。结果27例患儿均有典型颞叶癫痫临床表现,MRI发现一侧颞叶及海马异常信号影,发作间期及发作期VEEG提示异常放电起始于一侧额颞部。术中ECoG及深部电极监测均发现颞叶明显持续或阵发性尖波、棘波、棘慢复合波等癫痫样放电。27例患儿均采用标准前颞叶+病灶切除+周边异常放电颞叶皮质扩大切除术,其中2例患儿切除部分岛叶长回及额盖皮质热灼处理。随访6个月,EngelⅠ级患儿22例,EngelⅡ级患儿3例,EngelⅢ级患儿2例。结论早期手术、术中ECoG与深部电极联合监测下适度扩大切除范围是改善学龄前难治性颞叶癫痫患儿手术疗效的关键因素。     

痫性放电实现异体间转道并致痫动物的研究报道

目的观察青霉素癫痫模型痫性放电能否被引导电极转道至异体大鼠脑内并致痫。方法实验大鼠海马局部注射青霉素建立癫痫模型,通过引导电极拟将痫性放电导入异体大鼠同侧海马,观察实验大鼠的行为学、脑电图变化。结果致痫组、痫能导出组12只大鼠全部点燃,痫能导入组6只大鼠亦出现痫性发作,痫能导出组痫性发作时程缩短,致痫组、痫能导出组、痫能导入组大鼠脑电图均可记录到痫性波;对照组、电极组无痫性发作。结论实验性痫性放电可通过引导电极在异体大鼠脑组织间传导,脑内痫性放电有可能被电极导出。     

额叶癫痫的长程视频脑电特征及其在额叶癫痫诊断和外科定位中的应用

目的探讨长程视频脑电（VEEG）在额叶癫痫诊断及手术定位中应用的意义。方法回顾性分析47例诊断为额叶性癫痫并进行手术治疗患者的长程视频脑电特征及临床资料。结果癫痫临床发作有以下特点：①持续时间短;②睡眠中较多见;③继发难治全身性发作多见;④强直性或运动性姿势症状突出;⑤常伴发声。癫痫发作间期VEEG存在以下形式：①脑电无异常;②一侧额部或一侧前头部异常波形波幅优势;③额部或前头部异常波形波幅优势且双侧对称;发作期VEEG存在以下形式：①多见去同步化低电压;②一侧或双侧额叶低幅快活动;③一侧或双侧额叶的高幅优势放电;④全导联同步对称异常放电。38例患者的癫痫灶术前被精确定位,9例患者癫痫灶术前不能确定侧别。结论应用长程视频脑电监测能够较全面了解额叶癫痫临床发作表现及脑电图特点,有助于准确诊断及术前定位。     

Ictal yawning in a patient with drug-resistant focal epilepsy: video/EEG documentation and review of literature reports

Yawning is an involuntary sequence of mouth opening, deep inspiration, brief apnea, and slow expiration. Few cases of yawning as a clinical sign of epileptic seizures, ictally or postictally, have been reported. We report the video/EEG documentation of yawning as an ictal sign in a 31-year-old patient affected by drug-resistant focal epilepsy symptomatic of bilateral perisylvian polymicrogyria. Since the age of 10 she has had seizures characterized by yawning, staring, and eye blinking. Bilateral rhythmic frontotemporal spikes and waves characterized her EEG. We reviewed all reported cases and compared clinical and EEG features. We believe that yawning as part of an epileptic seizure might be considered a rare automatic behavior, like other automatisms frequently reported in epileptic seizures. Automatisms are more frequently described in patients with temporal lobe epilepsy, and involvement of the temporal lobe in most of the published cases may have led to this explanation. It is possible that yawning within epileptic seizures could be considered activation of distinct symptomatogenic cortex rather than a release phenomenon. This rare ictal manifestation should be recognized as epileptic to avoid misdiagnosis and treatment failure.     

功能性大脑半球切除术治疗顽固性癫痫

目的 探讨功能性大脑半球切除术治疗顽固性癫痫伴有偏瘫患者的效果.方法 自2002年4月至2007年12月,笔者协助6家兄弟医院采用功能性大脑球切除术治疗8例癫痫伴有一侧半球萎缩患者.8例均经头皮脑电图和视频脑电图检查,7例病侧半球有痈波,另1例对侧(正常侧)半球有痫波.脑MRI检查均显示一侧半球广泛性萎缩改变,脑室扩大显著.在吸取Schramm等改良的功能性大脑半球切除技术基础上,采用Rasmussen的方法进行手术.结果 随访期8个月至6.4年,平均2.8年.术后癫痫控制结果采用国内术后结果评估方案评估:满意(癫痫发作完全消失)7例,但其中1例术后癫痫完全消失2年,后因自行停药,癫痫再发,经改用2种抗痈药后至今未发作;显著改善(癫痫发作减少70%)1例.术后抗痫药剂量、种类与术前相比有减少者6例,术后停药者2例.本组无死亡及严重的并发症,仅1例在同手术期发生急性癫痫持续状态,经抢救治愈.术后脑电图病侧半球6例无痫波,对侧半球(非手术侧)有痫波者2例.偏瘫情况:7例偏瘫不加重,其中6例瘫痪肢体功能有恢复,但拇指功能大多无改善;1例术后暂时性肌力下降,术后逐渐恢复并有好转.一般生活状态表现为术后性格变得温顺合作,已能上学4例,家务劳动2例,休息2例.结论 功能性大脑半球切除术治疗顽同性癫痫伴一侧半球病损的患者效果满意,且该手术并发症发生率低,值得推广应用.