128导长程视频脑电图系统在耐药性癫痫治疗中的应用

目的：观察128导长程视频脑电图系统在耐药性癫痫术前致痫灶定位、手术方式的选择及术后疗效评价中的作用。方法耐药性癫痫22例患者,采用光电128导癫痫定位系统EEG9200 K脑电图机行头皮脑电图监测,并与PET及头颅核磁检查结果进行比对。结果①9例患者头皮脑电图、头颅核磁、PET检查结果致痫灶吻合,分别进行手术治疗。术后随访3～36个月。3个月后9例患者均再次进行头皮脑电图监测,未发现癫痫发作。且随访中未见癫痫发作。②13例患者根据发作类型,经头皮脑电图、头颅核磁、PET检查后,致痫灶无法准确定位,行颅内电极及深部电极置入术,应用128导脑电图机行颅内电极脑电图长程监测,同时对功能区进行定位,选择了相应的手术方式进行治疗。术后随访3～32个月。术后3～6个月13例患者再次进行头皮脑电图监测,未见癫痫发作。11例随访中未见癫痫发作,2例术后6个月出现癫痫发作,加大抗癫痫药物剂量后未见癫痫发作。结论头皮脑电图、头颅核磁、PET检查结果致痫灶吻合可定位的应积极行手术治疗,无法定位致痫灶的患者应用128导脑电图机行颅内电极脑电图长程监测可明确致癫灶,部分可进行功能区定位,选择相应的手术方法,效果良好。颅内电极脑电图可作为致痫灶定位及手术方式选择的“金标准”。     

颞叶癫痫73例手术治疗分析

目的探讨外科手术治疗颞叶癫痫的疗效。方法术前对73例颞叶癫痫患者行长程视频脑电图和MRI明确病灶,44例行颞叶部分切除＋海马杏仁核部分切除术,7例行选择性海马杏仁核切除术,22例行病变切除＋周围皮层电灼术。记录术后2周内疾病发作情况及术后2周时脑电图情况;术后1a行疗效评定。结果术后2周内临床发作3例,均为小发作,术后2周时脑电图均未见棘波、棘—慢波、棘—尖波等痫样放电。术后1a疗效满意49例,显著改善15例,良好9例。结论手术治疗颞叶癫痫的效果良好;术前长程视频脑电图检测和头颅MRI检查是颞叶癫痫致痫灶定位可靠的无创性检查方法。     

标准前颞叶切除术治疗颞叶癫痫预后影响因素

接受标准前颞叶切除术治疗的颞叶癫痫(TLE)患者27例,根据预后将患者分为满意组与非满意组,对两组患者术前发作形式、影像学检查结果 和脑电图情况等进行统计分析.结果 27例患者中20例效果满意,满意率74%;比较发现部分性发作、影像学病变单一或发作间期癫痫放电局限者行标准前颞叶切除术治疗满意率较高.提示标准前颞叶切除术为TLE治疗的重要手段,手术前充分认识发作形式、影像学检查结果 和脑电图特点,对提高手术满意率有重要意义.     

癫痫发作后游走的研究

目的 探讨癫痫患者发作后游走的临床特点.方法 选择我中心2009～2010年进行术前评估的66例患者,其中30例患者诊断为颞叶癫痫,其余36例患者为颞叶外癫痫,回顾分析患者发作症状学、脑电图、MRI和治疗等相关资料.结果 癫痫发作后游走在颞叶癫痫中比颞叶外癫痫中常见,多次痫性发作后比单次痫性发作后常见,非优势侧较优势侧常见.结论 发作后游走是癫痫发作的常见并发症,早期识别对治疗和防止严重的意外伤害都是至关重要的.     

难治性癫痫的病灶定位和手术治疗

目的探讨难治性癫痫的致痫灶定位和手术治疗方法。方法对150例难治性癫痫患者的临床资料作回顾性分析。结果本组术前均行冠矢状位轴位MRI检查、视频脑电图（VEEG）检查,其中20例行脑PET—CT显像;在皮质脑电图（EcoG）监测下切除致痫灶,包括局部癫痫灶切除59例,前颞叶及颞叶加杏仁核、海马切除50例,选择性杏仁核、海马切除3例,额叶病灶切除28例,额叶加颞叶病灶切除7例,大脑半球切除3例。术前MRI、VEEG和PET—CT定侧定位准确率分别为70．6％、83．5％、94．4％。术后随访1．5a,疗效I级（Engel分级）57例、Ⅱ级52例、Ⅲ级33例、Ⅳ级8例。结论综合应用MRI、脑电图以及核素检查可更准确地定位致痫灶,在EcoG监测下行致痫灶切除手术效果较好。     

颞叶癫痫术前定位方法的评价

目的 探讨颞叶癫痫不同术前定位方法的效果。方法 回顾性分析58例难治性颞叶癫痫手术患者的临床资料。分别统计头皮脑电图、视频脑电监测、皮层电极、深部电极、头颅CT、MR1、PET七种检查定位方法的阳性结果，计算出准确定位率，对数据进行统计学分析。结果 CT、头皮脑电图的定位能力明显低于视频脑电监测、皮层电极、深部电极监测及MRI、PET检查，后五种评估方法的定位能力无显著差异。结论 上述术前定位方法单一应用不具有特异性．颞叶癫痫灶的准确定位需综合应用各种定位方法。     

手术治疗顽固性颞叶癫痫(附23例报告)

目的探讨颞叶癫痫手术适应证与术式选择。方法根据发作类型和表现、发作间期EEG及头颅MRI扫描，选择顽固性颞叶癫痫综合征23例进行手术治疗，其中单侧海马硬化16例。行前颞叶切除术7例，经颞中回侧脑室入路与经侧裂侧脑室入路选择性杏仁核海马切除术分别4、5例；蛛网膜囊肿2例仅行囊肿壁切除术；颞中回后部胶质瘤1例先行病灶切除术，术后因癫痫仍发作于术后第5天再次行前颞叶切除术；颞叶内侧肿瘤4例行肿瘤切除术加前颞叶切除术。术后随访3～22月。结果16例海马硬化中，2例术后1周内分别出现1次和2次强直阵挛发作．服卡马西平后未再发作，3例术后6～8个月的随访期内共发作1、3、3次，余11例未发作。蛛网膜囊肿者术后发作次数减少90％，颞叶肿瘤除1例术后第6天出现强直阵挛发作1次外未出现发作。结论在筛选颞叶癫痫手术适应证时，应注意癫痫发作形式和MRI表现，根椐病因选择术式。     

脑磁图与头皮视频脑电图在颞叶癫痫的应用比较

目的比较脑磁图与头皮视频脑电图（VEEG）对癫痫灶定位的应用前景。方法对69例癫痫患者进行手术治疗,术前均通过VEEG、脑磁图检查,进行两者在定侧、定叶诊断的对比研究。手术在VEEG及脑深部脑电图监测下进行,手术治疗结果以Engel疗效分级评价。结果69例患者中MEG定位局限于单个叶的为62例,VEEG仅为30例。脑磁图比术前VEEG检查有定侧意义,二者之间的差异有统计学意义（χ^2=30．250,P=0．000）。36例术前VEEG表现为双侧或者全导癫痫波的颞叶癫痫患者,其中有34例脑磁图表现为单侧癫痫波,具有定侧诊断的意义。结论综合比较脑磁图比VEEG对难治性颞叶癫痫患者的定位准确性高。脑磁图空间分辨率、时间分辨率高,可以有助于区分致痫灶和镜灶。     

18F-FDG PET对于MRI阴性的颞叶癫痫术前定位和预测疗效的价值

目的评价18F-FDG PET对于MRI阴性的难治性颞叶癫痫术前定位,合理选择适应证及预测手术疗效的价值。方法对25例MRI阴性的颞叶癫痫患者,经过头颅MRI、视频脑电图及18F-FDG PET-CT等术前评估后均行颞叶切除术,术后随访手术疗效,采用Engel分级评价疗效,比较PET-CT与同期脑电图定位的准确性及脑代谢改变的不同图形与手术疗效的关系。结果头颅MRI阴性的患者颞叶切除术后疗效达到EngelⅠ级13例(52%),Ⅱ级2例(8%),Ⅲ级5例(20%),Ⅳ级5例(20%),有效率80%,显效率60%。在Engel疗效分级Ⅰ,Ⅱ级的15例患者中,PET-CT、VEEG定位的准确性分别为86.7%、46.7%,经卡方检验差异,差异无统计学意义。PET-CT代谢减低局限于颞叶者手术效果好,超出颞叶甚至表现为双侧颞叶代谢减低者手术疗效不佳。结论 PET对于癫痫病灶定位的灵敏度和准确性优于视频脑电图。PET-CT的代谢图形可帮助无病灶颞叶癫痫确定病灶部位,选择手术适应证和预测疗效。     

脑电图对癫痫自动症定位的诊断价值

目的分析癫痫自动症的临床和脑电图(EEG)特征,探讨EEG在癫痫自动症诊断中的意义。方法对46例癫痫自动症患者的临床、神经影像学和EEG进行分析。结果46例患者中,以口咽自动症多见(35／46例),其中以颞叶癫痫居多,言语自动症癫痫活动多起源于非优势半球,过度运动仅见于额叶癫痫;睡眠中或发作期额区起源特征性放电在额叶癫痫定位诊断中价值较高;对颞叶癫痫的诊断蝶骨电极价值较为可靠。结论自动症是多种类型癫痫发作所共有的特征．在其定位诊断中EEG有较高辅助诊断价值。     

颞叶癫(癎)的临床特征和脑电图分析

目的分析和总结颞叶癫癎的临床、脑电图特征。方法对2004年6月至2006年1月于首都医科大学北京天坛医院癫癎中心门诊和病房确诊为颞叶癫癎的145例患者的临床、脑电图和神经影像学资料进行分析。结果患者的发作类型包括简单和复杂部分性发作以及全面强直阵挛发作,以复杂部分性发作最常见。病因分析显示,45例病灶性颞叶癫癎的病因依次为脑血管病、颅内感染、脑外伤等,100例非病灶性颞叶癫癎中,海马硬化29例。脑电图显示颞区癫癎样放电。结论颞叶癫癎是一组临床常见、病因复杂、表现多样的癫癎综合征。正确诊断、规范化治疗是提高其疗效的关键。     

Temporal-insular spreading time in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy

Insular involvement in temporal lobe epilepsy (TLE) has gradually been recognized since the widespread use of stereoelectroencephalography (SEEG). However, the correlation between insular involvement and failed temporal lobe surgery remains unclear. In this study, we analyzed the surgical outcomes of TLE patients who underwent temporal and insular SEEG recordings and explored the predictors of failed anterior temporal lobectomy (ATL) in these patients with temporal seizures.Forty-one patients who underwent ATL for drug-resistant TLE were examined using temporal and insular SEEG recordings. The clinical characteristics, SEEG data, and postoperative seizure outcomes of these patients were analyzed, and multivariate analysis was used to identify the predictors of surgical outcome.In this series, the ictal temporal discharges invaded the insula in 39 (95.1%) patients. Twenty-three (56.1%) patients were seizure-free (Engel class I) after ATL with at least 1 year follow-up. Only temporal-insular spreading time (TIST) was an independent predictor of postoperative seizure-free outcomes (P = .035). By creating receiver operating characteristic curves for TIST, 400 milliseconds was identified as the cutoff for classification. All patients were classified into 2 groups (TIST ≤ 400 milliseconds and TIST > 400 milliseconds) based on the cutoff value; the difference in seizure-free rates between the 2 groups was significant (P = .001).The very early insular involvement in TLE may be associated with poorer seizure outcomes after ATL. Our findings may be helpful for estimating the appropriate operative procedures and will be valuable for evaluating the prognosis of TLE patients with temporal-insular SEEG recordings and temporal lobectomy.     

颅内电极脑电监测辅助下难治性枕叶癫痫的外科治疗

目的初步探索在颅内有创脑电监测下进行难治性枕叶癫痫外科治疗的效果。方法回顾性分析8例应用有创脑电监测的枕叶癫痫病例,所有病例均经过磁共振(MRI)、正电子发射断层扫描(PET)、头皮视频脑电监测(VEEG)等术前评估,初步判断癫痫起源在枕叶,再应用有创脑电监测,进一步明确致痫区的位置和范围,2期行致痫区手术切除。结果术后无死亡及严重并发症,其中1例视野缺损稍有加重。6例患者术后随访超过1 a,2例患者随访超过半年,其中6例术后无癫痫发作,2例发作次数明显减少。结论颅内电极长程脑电监测对于明确致痫区及视觉皮层、确定并精确切除致痫区具有重要意义,在其辅助下难治性枕叶癫痫的外科疗效提高,并发症减少。     

Referral of epileptic patients in North East Coast of West Malaysia an area with poor MRI coverage: an analysis

Advances in neuroimaging techniques, particularly Magnetic Resonance Imaging (MRI), have proved invaluable in detecting structural brain lesions in patients with epilepsy in developed countries. In Malaysia, a few electroencephalography facilities available in rural district hospitals run by trained physician assistants have Internet connections to a government neurological center in Kuala Lumpur. These facilities are more commonly available than MRI machines, which require radiological expertise and helium replacement, which may problematic in Southeast Asian countries where radiologists are found in mainly big cities or towns. We conducted a cross-sectional study over a two year period begining January 2001 on rural patients, correlating EEG reports and MRI images with a clinical diagnosis of epilepsy to set guidelines for which rural patients need to be referred to a hospital with MRI facilities. The patients referred by different hospitals without neurological services were classified as having generalized, partial or unclassified seizures based on the International Classification of Epileptic Seizures proposed by the International League Against Epilepsy (ILAE). The clinical parameters studied were seizure type, seizure frequency, status epilepticus and duration of seizure. EEG reports were reviewed for localized and generalized abnormalities and epileptiform changes. Statistical analysis was performed using logistic regression and area under the curve. The association between clinical and radiological abnormalities was evaluated for sensitivity and specificity. Twenty-six males and 18 females were evaluated. The mean age was 20.7 +/- 13.3 years. Nineteen (43.2%) had generalized seizures, 22 (50.0%) had partial seizures and 3 (6.8%) presented with unclassified seizures. The EEG was abnormal in 30 patients (20 with generalized abnormalities and 10 localized abnormalities). The MRI was abnormal in 17 patients (38.6%); the abnormalities observed were cerebral atrophy (5), hippocampal sclerosis (4), infarct/gliosis (3), cortical dysgenesis (2) and tumors (2). One patient had an arachnoid cyst in the right occipital region. Of the 17 patients with an abnormal MRI, 14 had an abnormal EEG, this difference was not statistically significant. There was no significant associaton between epileptographic changes and MRI findings (p = 0.078). EEG findings were associated with MRI findings (p = 0.004). The association between an abnormal EEG and an abnormal MRI had a specificity of 82.4%, while epileptogenic changes had a specificity of 64.7% in relation to abnormal MRI findings. This meants that those patients in rural hospitals with abnormal EEGs should be referred to a neurology center for further workup and an MRI to detect causes with an epileptic focus.     

Preictal Dynamics of EEG Complexity in Intracranially Recorded Epileptic Seizure: A Case Report

Recent findings suggest that neural complexity reflecting a number of independent processes in the brain may characterize typical changes during epileptic seizures and may enable to describe preictal dynamics. With respect to previously reported findings suggesting specific changes in neural complexity during preictal period, we have used measure of pointwise correlation dimension (PD2) as a sensitive indicator of nonstationary changes in complexity of the electroencephalogram (EEG) signal. Although this measure of complexity in epileptic patients was previously reported by Feucht et al (Applications of correlation dimension and pointwise dimension for non-linear topographical analysis of focal onset seizures. Med Biol Comput. 1999;37:208–217), it was not used to study changes in preictal dynamics. With this aim to study preictal changes of EEG complexity, we have examined signals from 11 multicontact depth (intracerebral) EEG electrodes located in 108 cortical and subcortical brain sites, and from 3 scalp EEG electrodes in a patient with intractable epilepsy, who underwent preoperative evaluation before epilepsy surgery. From those 108 EEG contacts, records related to 44 electrode contacts implanted into lesional structures and white matter were not included into the experimental analysis.The results show that in comparison to interictal period (at about 8–6 minutes before seizure onset), there was a statistically significant decrease in PD2 complexity in the preictal period at about 2 minutes before seizure onset in all 64 intracranial channels localized in various brain sites that were included into the analysis and in 3 scalp EEG channels as well. Presented results suggest that using PD2 in EEG analysis may have significant implications for research of preictal dynamics and prediction of epileptic seizures.     

癫癎发作后头痛的临床特征及其危险因素

目的　为研究癫疒间 发作后头痛 (post ictalheadaches,PIH)的临床特征及其发生的危险因素。 方法　采用病史询问方法对 97例与部位有关的癫疒间患者头痛的临床特征进行研究。结果　发现PIH一般表现为搏动性头痛 ,咳嗽、呕吐、弯腰、喷嚏、突然头部运动等能使头痛加重 ,部分患者伴有恶心、呕吐、畏光、怕声等症状 ,睡眠能使部分患者头痛减轻和缓解。PIH的发生率为 3 6 1% ,致疒间 灶的部位不同其PIH发生率也不同 ,颞叶癫疒间PIH的发生率为 2 1 3 % ,枕叶癫疒间为 61 9% ,额叶癫疒间 为 41 4% ,枕叶明显高于颞叶和额叶 (P <0 0 5 ) ,另外强直 -阵挛性发作患者PIH发生率高于其它类型发作 ,发病年龄越轻的患者PIH发生率越高。结论　PIH与偏头痛具有某些共同临床特点。其发生机制可能与致疒间灶的部位及疒间性放电扩布范围有关