癫癎发作期PET定位药物难治性癫癎1例并文献复习

目的：探讨药物难治性癫癎患儿在注射18F-DG药物时发生癫癎发作后所查正电子发射断层扫描（PET）显示局灶性高代谢灶的意义，并复习相关文献。方法：1例1岁零2个月女性患儿有发作性抽搐伴意识丧失13个月，智能发育落后于正常同龄儿童，视频脑电图显示左颁局限性癎样放电，MRI显示左侧颁叶局灶病变，在注射18F-DG药物时发生癫癎发作，斯时所查PET-CT显示左颁局灶性高代谢灶，因为与无创检查结果定位一致，遂行左侧颁叶后部癎灶切除术加中央前回软脑膜下横纤维切断术。结果：术前服用抗癫癎药物状态下每日发作数10次，术后6个月患儿癫癎完全缓解，切除组织病理学提示局灶性皮质发育不良（FCDIIb），手术后13d视频脑电图正常，6个月脑电图左侧额区尖波。患儿手术后6个月时智力有所进步，但仍落后于正常同龄儿。有文献显示在癫癎发作期注射18F-DG后PET在局灶性癫痂患者中一般显示局灶高代谢灶，并能定位政癎灶。结论：癫癎发作期注射18F-DGPET所显示的局灶高代谢区对致癎灶定位有很大帮助。

A case analysis of ictal PET to locate the epileptogenic zone and literature review

Objective： To investigate the value of ictal PET-CT to locate the epileptogenic zone while epileptic seizure occurred at the time of 18F-DG injection, and to review the relative literature. Methods：A female child of one year and two month with intractable epilepsy and cerebrum dysplasia un- derwent an epileptic foci resection and multiple subpial transection with the V-EEG and MRI,and ictal PET abnormality was found on the left frontal area. Results：Before operation,the patient with antiepilep- tic drug had frequently epileptic seazures. After operation, the patient had not epileptic seazure within 6 months. The literature suggests that patients with focal epilepsy usually have focal high metablic zone on 18F-DG PET imaging. Conclusion ; The focal high metablic zone on ictal PET can help locate the epilepto- genic zone.