难治性癫痫的研究进展

癫痫长期反复发作给病人的身心健康带来极大的危害,其中相当一部分癫痫病人使用抗癫痫药物得不到很好控制而成为难治性癫痫,近年来日益引起人们的关注。本文对难治性癫痫的概念、病因、常见类型及治疗的研究进展进行综述。     

功能磁共振成像在难治性癫痫的研究进展

近年来脑功能磁共振成像(fMRI)发展较快,对癫痫的研究,特别在难治性癫痫的病因诊断、痫灶定位、癫痫手术术前方案制定等方面的应用研究获得了重大进展。可用于检出微小或特殊的致痫灶如皮质发育障碍、微小动静脉畸形、动脉瘤和肿瘤等,更多用于术前脑功能的定位,术中癫痫灶的切除范围,术后功能恢复预测等。     

头颅MRI正常表现的难治性癫痫患者手术治疗探讨

对于难治性癫痫患者行头颅MR I检查时,发现颞叶内侧硬化、皮层发育不全、肿瘤或血管畸形等疾病,其往往提示癫痫手术治疗后具有较好的疗效,一般可以达到6 5%~9 0%以上的癫痫发作缓解率;故头颅MR I对发现难治性癫痫的病灶具有独特的诊断价值,尤其是颞叶癫痫。但仍有2 0%~3 0%的癫痫患者,在高分辨率的MR I检查下不能发现任何异常;本文主要就头颅MR I正常表现的难治性癫痫患者影像学认识、手术治疗的必要性及疗效等方面进行探讨。     

难治性癫痫的诊断和治疗

难治性癫痫是指临床经过迁延 ,对抗癫痫药物治疗反应差的癫痫 ;儿童以Ｌｅｎｎｏｘ Ｇａｓｔａｕｔ综合征 ,成人以难治性颞叶癫痫为代表。真正的难治性癫痫仅为癫痫人群中的一小部分 ,约占 2 0 %～ 2 5 %。用严格的定义来规范难治性癫痫是因为近 2 0余年来外科手术已成为难治性癫痫治疗的一种重要手段 ,选择癫痫灶切除的患者应符合难治性的标准。不应将凡是治疗效果不佳者均归入难治之列。临床实践证明 ,只要通过及时而正确的诊断及合理的治疗 ,大部分癫痫发作均有可能得到缓解乃至痊愈。一、难治性癫痫的定义难治性癫痫是指临床经过迁延 ,…     

FLAIR在中风后迟发性癫痫中的应用价值研究

目的：探讨FLAIR在中风后迟发性癫痫诊断中的应用价值。方法：对48例中风后迟发性癫痫在进行常规MRI扫描后加用FLAIR技术扫描。对常规扫描及FIAIR扫描结果分析。结果：在48例中风后迟发性癫痫患者中有45例（93．8％）的病灶在FLAIR扫描中不能被完全抑制而呈斑片状或线条状高信号。结论：对中风后迟发性癫痫在MRI常规扫描基础上加用FLAIR扫描可提高对病灶中胶质增生，疤痕组织检出，作为判断预后追踪观察的指标，同时对手术治疗提高可靠的影像学依据。     

难治性癫痫的MR影像学研究

用ＭＲＩ和ＣＴ对５０例难治性癫痫患者同时进行ＭＲＩ，ＣＴ扫描，并进行对照。结果：ＭＲＩ异常４１例，病灶７０个，多发灶２２例，颞叶异常３０例，ＣＴ异常２８例，病灶３６个，多发灶８例，颞叶异常１６例，ｘ＾２检验Ｐ〈０．０１，两者有显著性差异。     

难治性癫痫的临床研究

本文研究了１１２例难治性癫痫，发病率为１９．８％。症状性癫痫、婴儿痉挛症、伴有神经缺陷及精神发育不全、脑电图背景活动异常、癫痛虽混合性发作及有癫痫家族史的患者，认为是难治性癫痫的危险因素．脑电图异常率为９６．３％。ＣＴ扫描异常率为７７．６％；包括脑萎缩、脑内钙化、脑穿通畸形、脑灰质移位症、透明膈缺失、脑室囊肿等。认为ＣＴ扫描对本病的病因诊断有重要价值。本病疗效较差，预后不良。     

MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.     

难治性癫痫的研究进展

癫痫的长期反复发作,不仅使患者躯体遭受痛苦,而且在一定程度上可导致精神及社会心理障碍。因此,近年来对难治性癫痫的诊断及治疗引起了人们极大关注。本文综述了难治性癫痫的概念及内外科治疗的研究进展。     

难治性癫痫手术治疗进展

磁共振成像技术与电生理技术为难治性癫痫的诊断提供了有力的技术支持。神经导航技术、手术中磁共振成像技术等提高了操作的准确性。其他新技术例如软膜下多重横切术、迷走神经直接或间接刺激术也有效应用于临床。通过研究经典神经外科切除手术与采用新技术在治疗上的差异,分析了目前难治性癫痫手术的治疗结果,证实手术治疗对于药物难治性癫痫患者是安全有效的。     

维拉帕米治疗难治性癫痫机制的研究

目的 研究抑制P-糖蛋白（p-glycoprotein，P-gp）的表达对难治性癫痫的治疗作用。方法用氯化锂-匹鲁卡品制作慢性颞叶癫痫模型，采用免疫组化法检测P-gp的表达水平；给予P-gp抑制剂维拉帕米，观察其对P-gp的抑制作用及大鼠癫痫发作的影响。结果难治性癫痫组P-gp表达水平较对照组明显增高，P-gp抑制剂维拉帕米可显著降低P-gp的表达水平，大鼠癫痫发作次数明显减少。结论 P-gp过度表达在难治性癫痫耐药性的产生中起重要作用。     

儿童难治性癫痫的手术治疗

癫痫是儿童神经系统常见疾病之一,其发病原因、临床表现及治疗原则较成人癫痫具有明显差异.随着抗癫痫药物的不断创新、扩展及人们对癫痫的深入研究,大多数癫痫患儿可以得到理想的控制,但仍有部分患者经药物治疗无效而成为难治性癫痫,是外科干预治疗的潜在目标.近年来手术治疗难治性癫痫的技术得到迅速发展,特别是针对儿童难治性癫痫的手术治疗取得重大突破.目前用于儿童癫痫的外科治疗方法主要有切除性手术、毁损性手术、阻断通路手术和神经调控手术等.     

MRI-negative refractory partial epilepsy: role for diffusion tensor imaging in high field MRI

OBJECTIVE: Our aim is to use the high field MR scanner (3T) to verify whether diffusion tensor imaging (DTI) could help in locating the epileptogenic zone in patients with MRI-negative refractory partial epilepsy. METHOD: Fifteen patients with refractory partial epilepsy who had normal conventional MRI, and 40 healthy volunteers were recruited for the study. DTI was performed on a 3T MR scanner, individual maps of mean diffusivity (MD) and fractional anisotropy (FA) were calculated, and Voxel-Based Analysis (VBA) was performed for individual comparison between patients and controls. RESULT: Voxel-based analysis revealed significant MD increase in variant regions in 13 patients. The electroclinical seizure localization was concurred to seven patients. No patient exhibited regions of significant decreased MD. Regions of significant reduced FA were observed in five patients, with two of these concurring with electroclinical seizure localization. Two patients had regions of significant increase in FA, which were distinct from electroclinical seizure localization. CONCLUSION: Our study's results revealed that DTI is a responsive neuroradiologic technique that provides information about the epileptogenic areas in patients with MRI-negative refractory partial epilepsy. This technique may also helpful in pre-surgical evaluation.     

Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy

Purpose: To assess the impact of contralateral magnetic resonance imaging (MRI) findings on seizure outcome after hemispherectomy for refractory epilepsy. Methods: We retrospectively reviewed 110 children, 0.4–18 (median 5.9) years of age, who underwent hemispherectomy for severe refractory epilepsy at Cleveland Clinic Children’s Hospital. In children with contralateral (as well as ipsilateral) MRI findings appreciated preoperatively, the decision to proceed to surgery was based on other features concordant with the side with the most severe MRI abnormality, including ipsilateral epileptiform discharges, lateralizing seizure semiology, and side of hemiparesis. Results: We retrospectively observed contralateral MRI abnormalities (predominantly small hemisphere, white matter loss or abnormal signal, or sulcation abnormalities) in 81 patients (74%), including 31 of 43 (72%) with malformations of cortical development (MCD), 31 of 42 (73%) with perinatal injury from infarction or hypoxia, and 15 of 25 (60%) with Rasmussen’s encephalitis, Sturge‐Weber syndrome, or posttraumatic encephalomalacia. Among 84 children (76%) with lesions that were congenital or acquired pre‐ or perinatally, 67 (83%) had contralateral MRI abnormalities (p = 0.02). Contralateral findings were subjectively judged to be mild or moderate in 70 (86%). At follow‐up 12–84 (median 24) months after surgery, 79% of patients with contralateral MRI abnormalities were seizure‐free compared to 83% of patients without contralateral MRI findings, with no differences based on etiology group or type or severity of contralateral MRI abnormality. Discussion: MRI abnormalities, usually mild to moderate in severity, were seen in the contralateral hemisphere in the majority of children who underwent hemispherectomy for refractory epilepsy due to various etiologies, especially those that were congenital or early acquired. The contralateral MRI findings, always much less prominent than those in the ipsilateral hemisphere, did not correlate with seizure outcome and may not contraindicate hemispherectomy in otherwise favorable candidates.     

Entorhinal cortex MRI assessment in temporal,extratemporal, and idiopathic generalized epilepsy

PURPOSE: We previously showed a reduction in the volume of the entorhinal cortex (EC) ipsilateral to the seizure focus in patients with intractable temporal lobe epilepsy (TLE). The purpose of this study was to examine the specificity of EC atrophy in epilepsy. METHODS: We performed volumetric measurement of the EC on high-resolution magnetic resonance imaging (MRI) in patients with TLE (n = 70), extratemporal lobe epilepsy (ETE; n = 18), and idiopathic generalized epilepsy (IGE; n = 20). EC volumes of epilepsy patients were compared with those of 48 age- and sex-matched normal controls. Within the TLE group, 63 patients were selected prospectively with hippocampal atrophy ipsilateral to the seizure focus. The remaining seven patients were chosen retrospectively based on normal volumetric MRI of the hippocampus and amygdale, as well as normal histopathologic examination of the resected tissue. RESULTS: Compared with normal controls, EC volume was smaller ipsilateral but not contralateral to the seizure focus in patients with TLE (p < 0.001). No difference in the EC volumes ipsilateral and contralateral to the seizure focus was seen in patients with ETE and IGE compared with normal controls. The individual analysis showed that the EC was atrophic in 73% of TLE patients with hippocampal atrophy. Three of the seven TLE patients with normal volumetric MRI of the hippocampus and amygdala and normal histopathologic examination had EC atrophy ipsilateral to the seizure focus. In no patient with ETE or IGE was the EC found to be atrophic. CONCLUSIONS: EC atrophy ipsilateral to the seizure focus appears to be specific to mesial temporal lobe structural damage associated with TLE.     

Rufinamide for refractory epilepsy in a pediatric and young adult population

This chart review investigated the efficacy and safety of rufinamide in 45 children and young adults who experienced a broad spectrum of partial and generalized seizure/epilepsy types which have been refractory to therapy. Of these patients, 19 (46%) achieved a >50% decrease in seizure frequency on rufinamide, and 7 patients achieved a >75% decrease in seizure frequency. While 17 (37.8%) patients stopped their trial of rufinamide prior to the end of the review period, only 2 (4.4%) were due to adverse effects. Although additional research must be done, this data shows promise that rufinamide is a safe and efficacious adjunct for cases of refractory epilepsy.     

拉莫三嗪治疗顽固性癫痫的临床观察

对３０例顽固性癫痫病人进行拉莫三嗪开放添加剂治疗。为期三个月。以后仍服用，剂量１００－４００ｍｇ／ｄ３０例患者总的癫痫发作次数减少４６％，１３％完全控制。拉莫三嗪对控制各类癫痫发作均有效，总显效率达６７％，不良反应较少，主要是变态反应性皮疹，停药后消失，实验室检查完全正常。     

MRI对颞叶癫痫的定侧诊断的价值

目的 观察颞叶癫痫患者的头颅MRI变化，探讨MRI对颞叶癫痫的定侧诊断价值。方法 采用头颅MRI检查，对40例颞叶癫痢患者及40例正常对照组的海马体积进行测量，将海马萎缩严重侧作为致瘌侧。结果 定量MRI对颞叶癫痢定侧敏感性为72．5％，特异性为85．3％。结论 头颅MRI扫描对颞叶癫痫的定位及定侧有着重要的诊断价值。