功能区病变致顽固性癫痫手术治疗新对策

目的探讨功能区病变伴顽固性癫痫的手术治疗中新技术与方法的研究。方法15例功能区病变伴顽固性癫痫病人均在术前常规MRI,EEG,术中应用皮层脑电图(ECoG)定位癫痫范围;包括涉及语言、运动等功能区者6例,利用喉罩麻醉、术中唤醒确定功能区范围,切除病变。结果镜下全切肿瘤9例,次全切除3例,额叶致痫灶切除2例,致痫灶及颞叶前部切除1例。随诊6个月至2年,癫痫消失11例,小剂量药物控制2例,肿瘤复发1例,术后功能保全13例。结论在功能区病变伴顽固性癫痫的手术中应用皮层脑电图、术中唤醒进行致痫灶、功能区双重定位有利于有效切除病变、治疗癫痫及保全功能。     

顽固性癫痫的病灶定位和术式选择（附82例分析）

1990～1998年,我们对82例不同类型的顽固性癫痫患者在皮层和深部电极监测下施行不同术式的外科治疗,术后近、远期疗效满意。1　资料与方法1.1　一般资料　本组男68例,女14例;年龄3～50岁。病程2～20年。电生理检查示中,重度异常EEG68例,有定侧、定位意义者51例。24小时脑电监测和视频脑电监测(VEEG)57例,除4例外,均见痫样放电波,并能对致痫灶进行定侧定位。硬膜下条状电极和深部电极定位者7例。本组均行CT和(或)MR检查,发现病灶位于额叶23例,颞叶21例,顶叶8例,枕叶4例,额颞顶多脑叶14例。影像学病灶和EEG致痫灶定位一致者65例。1.2　…     

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。     

立体定向融合影像技术在治疗脑动静脉畸形引发癫痫的定位作用

目的探讨立体定向结合脑血管造影与MRI影像融合在治疗脑动静脉畸形引发癫痫时对脑功能区、脑内病变和致痫灶空间范围的定位作用。方法对17例患者采用Talairach立体定向系统，绘制脑皮质表面血管图，并与三维MRI成像进行融合，标注脑功能区并设计术前深部电极放置部位和手术方案。结果17例患者获得了清晰的立体脑血管造影与MRI图像，涉及手术部位包括额叶8例、顶叶6例、颞叶2例和枕叶1例.手术完整切除动静脉畸形。术后随访1年，8例未见癫痫发作。结论该技术可以保证术前准确定位病灶，有利于术中判断脑沟回和功能区，避免损伤皮质功能区和血管。     

氢质子磁共振波谱在老年颞叶癫痫患者定位诊断中的价值

目的探讨氢质子磁共振波谱(1H-MRS)对老年颞叶癫痫患者定位诊断中的价值。方法老年颞叶癫痫患者(观察组)及基线资料相近的正常体检者(对照组)。均行头皮及24 h长程的脑电图(EEG)、额叶及双侧海马的1H-MRS检查。比较左、右侧不同部位海马区致痫侧、致痫侧对侧海马区NAA/(Cr+Cho)。结果观察组48例(其中23例致痫灶为右侧海马区,25例为左侧海马区),正常对照组42例。观察组左、右侧各个部位的海马区NAA/(Cr+Cho)比值均显著低于对照组(P均0.05);对照组左、右侧各部位的海马区NAA/(Cr+Cho)比值均无统计学差异(P均0.05);观察组致痫侧各个海马区NAA/(Cr+Cho)比值均显著低于致痫侧对侧(P均0.01)。结论1H-MRS检查在颞叶癫痫患者的定位诊断中有着非常重要意义。     

病灶性后皮层癫痫的临床特征及致痫灶定位研究

后皮层癫痫(posterior cortex epilepsy,PCE)是一组特定的癫痫综合征,其发作起始于枕叶、顶叶或后颞叶区域,或是其中2个或3个脑叶交界区起源癫痫的总称[1].PCE致痫灶定位困难,现就我院11例病灶性PCE患者致痫灶定位及手术效果总结如下.     

难治性枕叶癫痫的手术治疗（附7例报告）

目的分析难治性枕叶癫痫的手术治疗效果和视觉功能保护效果。方法对7例难治性枕叶癫痫患者,行视力视野检查,致痫灶行皮层或局部病灶及周围胶质增生带切除术,对5~10 s内迅速跟随发作起始的症状产生区行低功率皮层热灼术或局部皮层切除术,疑有功能区放电或发作起始者加行脑磁图功能区定位,功能区行低功率皮层热灼术,并注意保护好其白质传导纤维。其中确定发作起始于功能区的2例行功能区皮层热灼术。根据Engel′s术后效果分级评估疗效;行视力视野检查,观察术后患者视觉功能变化。结果术后随访6-12个月,6例无癫痫发作,达到Engel′sⅠ级,1例术后存在稀少癫痫发作,达到Engel′sⅡ级。6例（包括行功能区皮层热灼术2例）术后视觉功能无明显变化,1例视觉功能障碍较术前加重。结论定位明确的难治性枕叶癫痫患者可行致痫灶皮层或局部病灶及周围胶质增生带切除术;功能区低功率皮层热灼术可有效控制癫痫发作,且不造成功能缺失。术前精确定位功能区,术中保护功能区皮质及白质传导纤维,可有效减少视觉功能损伤机会。     

难治性癫痫三级脑电监测及显微手术干预30例疗效观察

目的探讨难治性癫痫三级脑电监测及显微手术干预的临床效果。方法对30例难治性癫痫患者进行常规头皮脑电图（EEG）和动态视频脑电图（VEEG）监测,结合CT、MRI、ECT影像表现,进行综合性评估,确定致痫灶;术中皮层脑电图（ECoG）及深部电极脑电图（DEEG）监测癫痫放电区域,麻醉唤醒后,皮层及深部电刺激验证,对孤立性癫痫病灶行显微手术切除,对多灶性或双侧独立的癫痫灶行胼胝体切开术,对位于皮质功能区癫痫灶行软脑膜下横切（MST）。结果30例难治性癫痫患者术后Engel分级：Ⅰ级19例,Ⅱ级10例,Ⅲ级1例,元Ⅳ级病例。所有患者术后无永久性神经功能缺失,无语言记忆功能障碍。结论VEEG＋MRI＋ECT＋ECoG或DEEG组合评估,对难治性癫痫致痫灶定位准确,显微手术后疗效良好。     

度洛西汀对50岁以上女性复发性抑郁障碍患者大脑皮层运动阈值和慢性皮层电位θ/β比值的影响

目的探讨度洛西汀对50岁以上女性复发性抑郁障碍患者大脑皮层运动阈值和慢性皮层电位的影响。方法选取女性复发性抑郁障碍患者27例,年龄50周岁,度洛西汀起始20 mg/d,1 w之内加至60 mg/d维持治疗;治疗前与治疗2 w后分别进行焦虑自评量表(SAS)、抑郁自评量表(SDS)、症状自评量表(SCL-90)测量;依瑞德磁场刺激仪(YRD CCY-I)检测大脑皮层运动阈值,在右侧前额叶给予对侧拇短展肌的皮质代表区的10次单脉冲刺激中至少有5次能够诱发出波幅50μV的运用诱发电位或肉眼可见的该肌肉收缩的最小功率,确定为该患者的r TMS运动阈值;伟思生物反馈治疗仪检测慢性皮层电位θ/β比值。结果治疗前与治疗2 w后相比,SAS、运动阈值均下降,但无统计学差异(P0.05);SDS、SCL-90总分均显著下降(P0.03);慢性皮层电位θ/β比值增加,但无统计学差异(P0.05)。SCL-90各因子分均普遍下降,其中抑郁改善明显(P0.05),躯体化、强迫、人际关系、焦虑、敌对、恐怖、偏执、精神病性及因子其他无统计学差异(P0.05)。结论度洛西汀对50岁以上女性复发性抑郁障碍患者抑郁症状改善明显,对改善焦虑症状、大脑皮层运动阈值和慢性皮层电位θ/β比值的无明显影响。     

以癫痫为首发症状的老年急性脑血管病32例临床分析

1996年 6月至 1999年 10月住院的 6 40例老年急性脑血管病中以癫痫为首发症状者 32例 ,其中男 18例 ,女 14例 ,年龄 6 0～ 88岁 ,平均年龄 74岁 ,蛛网膜下腔出血 8例 ,脑出血 10例 ,脑梗死 14例。病变部位 :蛛网膜下腔出血 8例脑出血 10例中 ,额叶出血 2例 ,出血量 2 4ｍＬ、40ｍＬ ;顶叶出血 1例 ,出血量 2 8ｍＬ ;颞叶出血 2例 ,出血量 2 8ｍＬ、36ｍＬ。枕叶出血 1例 ,出血量 32ｍＬ ;基底结区出血 4例 ,其中 1例出血 36ｍＬ。余 3例破入脑室。脑梗死 14例。额颞叶 2例 ,颞顶叶 1例 ,额颞顶 1例 ,颞叶 3例 ,枕叶 2例 ,基底结区 2例。脑室…     

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。     

Relation between hippocampal damage and cerebral cortical function in Alzheimer's disease

We investigated the relation between hippocampal damage and cerebral cortical dysfunction in Alzheimer's disease (AD) using MRI and SPECT. Nineteen patients with AD and 10 control subjects were studied. Hippocampal damage (including hippocampal formation, entorhinal cortex, and parahippocampal white matter) was assessed to evaluate the severity of atrophy and the magnetization transfer ratio (MTR) and cerebral cortical dysfunction was evaluated by quantitative cerebral blood flow (CBF) measurements using SPECT with 99mTc-ECD. Compared with controls, patients with AD had significantly more atrophy of the medial temporal lobe and a decrease in MTRs of the hippocampus and parahippocampus. There were significant correlations between the severity of hippocampal damage and regional CBF in temporoparietal lobes. Mini-Mental State Examination scores significantly correlated with the severity of hippocampal damage and regional CBFs in temporoparietal lobes. These results suggest that the functional effect of hippocampal damage occurs in temporoparietal lobes in AD, probably due to neuronal disconnections between hippocampal areas (including the entorhinal cortex) and temporoparietal lobes.     

Neural correlate of subjective sensory experience gradually builds up across cortical areas

When a sensory stimulus is presented, many cortical areas are activated, but how does the representation of a sensory stimulus evolve in time and across cortical areas during a perceptual judgment? We investigated this question by analyzing the responses from single neurons, recorded in several cortical areas of parietal and frontal lobes, while trained monkeys reported the presence or absence of a mechanical vibration of varying amplitude applied to the skin of one fingertip. Here we show that the strength of the covariations between neuronal activity and perceptual judgments progressively increases across cortical areas as the activity is transmitted from the primary somatosensory cortex to the premotor areas of the frontal lobe. This finding suggests that the neuronal correlates of subjective sensory experience gradually build up across somatosensory areas of the parietal lobe and premotor cortices of the frontal lobe.     

人类吞咽皮质的功能定位

目前人类吞咽皮质中枢的定位仍不明确,限制了对吞咽周围器官病理生理学改变的了解和吞咽康复治疗的发展。动物实验发现,非人灵长目动物的运动前区皮质、感觉运动区、额叶、顶叶、颞叶岛盖、眶额皮质和扣带回皮质与吞咽功能相关。最近,人们利用功能磁共振成像、正电子发射体层摄影和脑磁图等先进的技术手段发现人类吞咽需要多个脑区参与,主要集中在主要感觉运动区皮质/前运动区、前扣带、岛叶和顶枕区。然而,各个脑区的具体功能和作用以及脑区之间的相互联系仍不清楚,还需要进一步研究来明确。     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

Correlation between each task of the Mini-Mental State Examination and regional glucose hypometabolism in at-rest Alzheimer's disease patients

We investigated the relationship between each task of the Mini-Mental State Examination (MMSE) and regional glucose hypometabolism in patients with Alzheimer's disease (AD). We studied 38 patients with probable AD using 2-¹⁸F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET). The images were corrected for differences in FDG uptake by cerebellar normalization, and were spatially normalized into a standard stereotactic anatomical space using statistical parametric mapping (SPM). There was a positive correlation between FDG uptake and the MMSE subscores for temporal orientation in the bilateral temporal and frontal cortex, and cingulate gyrus; for spatial orientation in the left parietal cortex, bilateral frontal and temporal cortex, and cingulate gyrus; for attention and calculation in the left temporal and frontal cortex; for writing in the left temporal cortex; and for copying and drawing, the correlation was positive in the bilateral parietal and occipital cortex. The total MMSE score was positively correlated with FDG uptake in the left temporal and frontal lobe. Our study demonstrated that, in AD patients, the distribution of hypometabolism in the resting state was related to clinical symptoms and that MMSE scores reflected brain dysfunction in the left hemisphere. Correlation analysis using SPM and FDG PET is useful for the objective evaluation of cognitive tests and diagnostic scoring.     

轻度认知障碍患者多模态磁共振特征

目的 探讨轻度认知损害者(MCI)和阿尔茨海默病(AD)患者多模态磁共振成像特征与认知功能的关系.方法 共纳入9例遗忘型MCI,15例轻度AD及11例正常对照,以简明精神状况检查(MMSE)和认知功能筛查测验(CASI)评估总体认知功能,对高分辨率结构像进行基于体素形态学分析(VBM),测量扩散张量成像(DTI)图像、各脑区白质各向异性比值(FA)和平均表观弥散系数(ADC),分析脑结构萎缩及白质DTI指标与认知评分的相关性.结果 MMSE和CASI评分与颞、额、顶、扣带回、海马旁回等结构灰质体积改变呈正相关(P<0.001),MMSE和CASI总分与颞、顶叶以及海马旁回的FA值呈正相关,与ADC值呈负相关(P<0.05).结论 MCI和AD患者认知功能与颞、顶、海马旁回等脑区萎缩及白质微观结构损伤密切相关,多模态影像技术可作为认知损害脑机制研究的重要技术手段.     

The temporal lobe is a target of output from the basal ganglia.

The basal ganglia are known to receive inputs from widespread regions of the cerebral cortex, such as the frontal, parietal, and temporal lobes. Of these cortical areas, only the frontal lobe is thought to be the target of basal ganglia output. One of the cortical regions that is a source of input to the basal ganglia is area TE, in inferotemporal cortex. This cortical area is thought to be critically involved in the recognition and discrimination of visual objects. Using retrograde transneuronal transport of herpes simplex virus type 1, we have found that one of the output nuclei of the basal ganglia, the substantia nigra pars reticulata, projects via the thalamus to TE. Thus, TE is not only a source of input to the basal ganglia, but also is a target of basal ganglia output. This result implies that the output of the basal ganglia influences higher order aspects of visual processing. In addition, we propose that dysfunction of the basal ganglia loop with TE leads to alterations in visual perception, including visual hallucinations.     

Primary central nervous system lymphoma masquerading as herpes encephalitis: clinical, magnetic resonance imaging, and pathologic findings

An 84-year-old man presented with acute confusion, global aphasia, and fever. Magnetic resonance imaging (MRI) showed hyperintense lesions on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images predominantly affecting the cortical gray matter of the left mesial temporal and inferior frontal lobes, and insula. Acyclovir was prescribed for presumed viral encephalitis. Clinical and MRI worsening prompted a left temporal lobe biopsy that revealed primary central nervous system lymphoma (PCNSL). This case adds to the MRI spectrum of PCNSL and illustrates that it may mimic the clinical and MRI presentation of herpes simplex encephalitis.