枕叶癫痫的术前定位

目的:通过回顾分析9例枕叶癫痫患者的临床资料,讨论枕叶癫痫的临床特征和致痫灶的术前定位。方法:应用临床发作症状评估、CT/MRI扫描、SPECT/PET检查、长程视频脑电图监测、颅内电极记录以及皮层脑电监测等方法综合定位枕叶癫痫患者的致痫灶。结果:视觉先兆及头或眼向一侧偏转是最常见的发作早期改变;发作形式以复杂部分性发作为主,也可以继发全面性发作。致痫灶位于枕叶内侧面2例,背外侧面7例,其中致痫灶位于枕叶与顶叶的临界区1例,枕叶与颞叶的临界区或累及颞叶后部4例。术后随访1年以上,按照Engel's术后效果分级:Ⅰ级5例,Ⅱ级2例,Ⅲ级1例,Ⅳ级1例。结论:视觉先兆的出现常常提示致痫灶位于枕叶,MRI检查以及发作初始期头和眼向一侧偏转等症状学特点均有较高的定侧定位价值。当其他方法定位致痫灶较困难时,应用颅内电极记录有助于定位。

Pre-surgical Evaluation for Occipital Lobe Epilepsy

objective The aim of this study was to analyze clinical characteristics and localization of epileptogenic zones in 9 patients with occipitally originating seizures who underwent epilepsy surgery. Methods This study included patients whose subdurally recorded seizures arose from occipital lobe, or those with an occipital lesion whose removal reduced seizure quantity by > 90%. The epileptogenic zones in 9 patients with occipital lobe epilepsy were localized by semiologic features, neuroimaging, longterm video-EEC monitoring and chronic intracranial EEC monitoring. Result Visual aura and head and/or eye version were most common features in the beginning ofseizures. Partial complex attacks occurred in most patients,and secondarily generalized seizures developed in some patients. Epileptogenic zones were localized in mesial surface in 2, lateral surface in 7 patients, pari-etooccipital region in 1 and in 4 patients epileptogenic zones of occipital lobe also involved some part of posterior temporal lobe. All patients have beenfollowed up more than 1 year; class 1 was found in 5 patients, class Ⅱ in 2 patients, class Ⅲ and Ⅳ in 1 patient respectively. Conclusion Visual aura often suggests occipitally originating seizures, head poreye version in the beginning of seizures and positive MRI are valuable features in localization of epileptogenic zones. Chronic intracranial electrical recording obviously contribute to localization when other methods are not effective.